Provider Demographics
NPI:1104878255
Name:KIRAR, JILL ADRIANNE (DC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ADRIANNE
Last Name:KIRAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:ADRIANNE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5 S ALLIANCE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7174
Mailing Address - Country:US
Mailing Address - Phone:843-572-2224
Mailing Address - Fax:843-572-2274
Practice Address - Street 1:5 S ALLIANCE DR
Practice Address - Street 2:SUITE E
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7174
Practice Address - Country:US
Practice Address - Phone:843-572-2224
Practice Address - Fax:843-572-2274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2906OtherLICENSE
SCU94058Medicare UPIN