MEDICARE: DR. JUDSON LANE HELDRETH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	2254	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255309068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDSON LANE HELDRETH D.C.

Provider Business Mailing Address
First Line	:	929 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2137
Country	:	US
Telephone Number	:	803-356-8554
Fax Number	:	803-356-8245

Provider Business Practice Location Address
First Line	:	929 N LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2137
Country	:	US
Telephone Number	:	803-356-8554
Fax Number	:	803-356-8245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/23/2011

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