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General NPI Number Information
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NPI Number | 1831637065
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Entity Type | Organization
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Legal Business Name | JODON CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 149 RIVERWALK BLVD SUITE 6
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City | RIDGELAND
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State | SC
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Zip | 29936-8190
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Country | US
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Telephone | 843-645-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 3 HATHAWAY LN
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City | BLUFFTON
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State | SC
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Zip | 29910-5725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED EDWARD JODON
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Credential | D.C.
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Telephone | 724-570-9834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4179
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License Number State | SC
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