Provider Demographics
NPI:1912060948
Name:JAYNES, ROGER STEPHEN (DC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:STEPHEN
Last Name:JAYNES
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 1:1521 AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2921
Mailing Address - Country:US
Mailing Address - Phone:864-232-0082
Mailing Address - Fax:
Practice Address - Street 1:1521 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2921
Practice Address - Country:US
Practice Address - Phone:864-232-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor