Provider Demographics
NPI:1003026865
Name:LANGLEY, JERRY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:CHARLES
Last Name:LANGLEY
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 1:500 MILLS AVE
Mailing Address - Street 2:STE E
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4280
Mailing Address - Country:US
Mailing Address - Phone:864-616-9623
Mailing Address - Fax:
Practice Address - Street 1:500 MILLS AVE STE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4280
Practice Address - Country:US
Practice Address - Phone:864-233-3364
Practice Address - Fax:864-233-3464
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor