Provider Demographics
NPI:1467671735
Name:E AND G ST. JOHN LLC
Entity Type:Organization
Organization Name:E AND G ST. JOHN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:STJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-877-2521
Mailing Address - Street 1:34 PARKWAY COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5213
Mailing Address - Country:US
Mailing Address - Phone:864-877-2521
Mailing Address - Fax:864-877-3513
Practice Address - Street 1:34 PARKWAY COMMONS WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5213
Practice Address - Country:US
Practice Address - Phone:864-877-2521
Practice Address - Fax:864-877-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT327490281Medicare ID - Type Unspecified