Provider Demographics
NPI:1215066915
Name:JEMISON, DAVID E (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:JEMISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-3526
Mailing Address - Country:US
Mailing Address - Phone:717-291-2233
Mailing Address - Fax:717-509-8375
Practice Address - Street 1:148 N PRINCE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3526
Practice Address - Country:US
Practice Address - Phone:717-291-2233
Practice Address - Fax:717-509-8375
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004455L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAJE619509Medicare ID - Type Unspecified