Provider Demographics
NPI:1225231905
Name:FARMER, JASON BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRENT
Last Name:FARMER
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:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-2632
Mailing Address - Country:US
Mailing Address - Phone:803-741-4234
Mailing Address - Fax:
Practice Address - Street 1:2627 MILLWOOD AVE STE C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1273
Practice Address - Country:US
Practice Address - Phone:803-218-9886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3199111N00000X
FL10690111N00000X
OH4352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGK069ZOtherMEDICARE PTAN
SCCH3199Medicaid
FL220N9OtherBCBSFL PROVIDER
OH11798381OtherCAQH
SC304526OtherUNISON
SC000000523023OtherBCBS STATE CREDENTIAL
SCAA27709576OtherMEDICARE PTAN