Provider Demographics
NPI:1093906059
Name:LOWERY, JEREMY WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:WAYNE
Last Name:LOWERY
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 1:4800 WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5248
Mailing Address - Country:US
Mailing Address - Phone:864-292-7756
Mailing Address - Fax:864-292-7278
Practice Address - Street 1:4800 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5248
Practice Address - Country:US
Practice Address - Phone:864-292-7756
Practice Address - Fax:864-292-7278
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor