Provider Demographics
NPI:1366498073
Name:LAWRENCE, JERILYN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JERILYN
Middle Name:J
Last Name:LAWRENCE
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 1:134 OAK FOREST RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6148
Mailing Address - Country:US
Mailing Address - Phone:843-304-0757
Mailing Address - Fax:
Practice Address - Street 1:134 OAK FOREST RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6148
Practice Address - Country:US
Practice Address - Phone:843-304-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA13390281Medicare PIN