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General NPI Number Information
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NPI Number | 1982874699
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Entity Type | Organization
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Legal Business Name | JPETE LLC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1939 MAYBANK HWY SUITE C
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City | CHARLESTON
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State | SC
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Zip | 29412-2114
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Country | US
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Telephone | 843-795-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 1939 MAYBANK HWY
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City | CHARLESTON
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State | SC
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Zip | 29412-2114
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Country | US
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Telephone | 843-795-1999
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | JULIE PETERSON
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Credential | D.C.
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Telephone | 843-795-1999
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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 | 2166
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License Number State | SC
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