Provider Demographics
NPI:1255657573
Name:KERSH, JILLIAN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:KERSH
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 1:104 MAULDIN RD STE G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1221
Mailing Address - Country:US
Mailing Address - Phone:864-272-0132
Mailing Address - Fax:
Practice Address - Street 1:104 MAULDIN RD STE G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1221
Practice Address - Country:US
Practice Address - Phone:864-272-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010262111N00000X
SC3743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor