Provider Demographics
NPI:1164489332
Name:CARDINAL, JESSICA A (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:CARDINAL
Suffix:
Gender:F
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:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1322
Mailing Address - Country:US
Mailing Address - Phone:803-454-1096
Mailing Address - Fax:803-454-1095
Practice Address - Street 1:7522 IRMO DR
Practice Address - Street 2:STE 1
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8640
Practice Address - Country:US
Practice Address - Phone:803-454-1096
Practice Address - Fax:803-454-1095
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1649358508OtherGROUP NPI
SC1649358508OtherGROUP NPI