Provider Demographics
NPI:1033650304
Name:JODON, JARED EDWARD
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:EDWARD
Last Name:JODON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HATHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:149 RIVERWALK BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8190
Practice Address - Country:US
Practice Address - Phone:843-645-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor