Provider Demographics
NPI:1154553543
Name:BRADSHAW, BENJAMIN LELDON (DC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LELDON
Last Name:BRADSHAW
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 1:7 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1927
Mailing Address - Country:US
Mailing Address - Phone:803-469-0340
Mailing Address - Fax:803-469-0350
Practice Address - Street 1:7 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1927
Practice Address - Country:US
Practice Address - Phone:864-327-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor