Provider Demographics
NPI:1518992197
Name:DAVIS, JEFFERSON CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:CHARLES
Last Name:DAVIS
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 1:12307 HIGHWAY 707
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9740
Mailing Address - Country:US
Mailing Address - Phone:843-357-9495
Mailing Address - Fax:843-357-9440
Practice Address - Street 1:12307 HIGHWAY 707
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-9740
Practice Address - Country:US
Practice Address - Phone:843-357-9495
Practice Address - Fax:843-357-9440
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2482Medicaid
SCCH2482Medicaid