MEDICARE: JESSE PERSEGHIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH11877	FL
2	111N00000X	Chiropractor	4313	SC

General Provider Information

NPI Number	:	1972059004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE PERSEGHIN D.C.

Provider Business Mailing Address
First Line	:	1300 HOSPITAL DR STE 220
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3208
Country	:	US
Telephone Number	:	843-936-6238
Fax Number	:	843-936-6239

Provider Business Practice Location Address
First Line	:	1300 HOSPITAL DR STE 220
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3208
Country	:	US
Telephone Number	:	843-936-6238
Fax Number	:	843-936-6239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	12/20/2019

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