Healthcare Provider Details

I. General information

NPI: 1538741939
Provider Name (Legal Business Name): JENNIFER CHASON LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 04/25/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E SAINT JOHN ST
SPARTANBURG SC
29302-1505
US

IV. Provider business mailing address

16 TWINING TER
SPARTANBURG SC
29307-3700
US

V. Phone/Fax

Practice location:
  • Phone: 864-214-5963
  • Fax:
Mailing address:
  • Phone: 864-490-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9655
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: