Provider Demographics
NPI:1932422896
Name:BRADSHAW, JEANELLE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:MARIE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35979 BELL RD
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2442
Mailing Address - Country:US
Mailing Address - Phone:037-239-3557
Mailing Address - Fax:888-792-7952
Practice Address - Street 1:602 S KING ST STE 301
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3919
Practice Address - Country:US
Practice Address - Phone:703-723-9355
Practice Address - Fax:888-792-7952
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor