Provider Demographics
NPI:1477618262
Name:MATHEWSON, JAMES JON (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JON
Last Name:MATHEWSON
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 1:119 SPRING ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5259
Mailing Address - Country:US
Mailing Address - Phone:843-723-6475
Mailing Address - Fax:843-723-6397
Practice Address - Street 1:119 SPRING ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5259
Practice Address - Country:US
Practice Address - Phone:843-723-6475
Practice Address - Fax:843-723-6397
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1113Medicaid
SCT23772Medicare UPIN