Provider Demographics
NPI:1316260805
Name:JOLI LLC
Entity type:Organization
Organization Name:JOLI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-766-1255
Mailing Address - Street 1:1118 SAVANNAH HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7806
Mailing Address - Country:US
Mailing Address - Phone:843-766-1255
Mailing Address - Fax:843-766-3157
Practice Address - Street 1:1118 SAVANNAH HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7806
Practice Address - Country:US
Practice Address - Phone:843-766-1255
Practice Address - Fax:843-766-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty