Provider Demographics
NPI:1972059004
Name:PERSEGHIN, JESSE (DC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:PERSEGHIN
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 1:1300 HOSPITAL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3208
Mailing Address - Country:US
Mailing Address - Phone:843-936-6238
Mailing Address - Fax:843-936-6239
Practice Address - Street 1:1300 HOSPITAL DR STE 220
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3208
Practice Address - Country:US
Practice Address - Phone:843-936-6238
Practice Address - Fax:843-936-6239
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11877111N00000X
SC4313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor