Provider Demographics
NPI:1386731016
Name:SMITH, JIMMY L JR (DC)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:L
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 RIVER LANDING DR
Mailing Address - Street 2:SUITE 12D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7440
Mailing Address - Country:US
Mailing Address - Phone:843-971-8234
Mailing Address - Fax:843-971-6406
Practice Address - Street 1:130 RIVER LANDING DR
Practice Address - Street 2:SUITE 12D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7440
Practice Address - Country:US
Practice Address - Phone:843-971-8234
Practice Address - Fax:843-971-6406
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA0154Medicare PIN