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Individual
STEVEN HEADRICK
Active
Individual
STEVEN HEADRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C., DABCO
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
587
SD
111NX0800X
Orthopedic Chiropractor
587
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2C985HE
BCBSMN
MN
01
—
46-0461355
FED TAX ID
SD
05
—
7600752
—
SD
01
—
DP2373
RR MEDICARE GROUP PTAN
SD
01
—
P00740093
RR MEDICARE PTAN
SD
Enumeration date
11/29/2007
Last updated
09/22/2009
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