Provider Demographics
NPI:1881947919
Name:HEADLEY, JOSHUA BRUCE (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRUCE
Last Name:HEADLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 NORTH RHETT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4240
Mailing Address - Country:US
Mailing Address - Phone:843-744-2265
Mailing Address - Fax:843-747-4421
Practice Address - Street 1:5122 NORTH RHETT AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4240
Practice Address - Country:US
Practice Address - Phone:843-744-2265
Practice Address - Fax:843-747-4421
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor