Healthcare Provider Details

I. General information

NPI: 1114831799
Provider Name (Legal Business Name): JORDYN WATSON SPIRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CHAPIN RD
CHAPIN SC
29036-9302
US

IV. Provider business mailing address

1400 CHAPIN RD
CHAPIN SC
29036-9302
US

V. Phone/Fax

Practice location:
  • Phone: 803-243-9756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12465
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: