Provider Demographics
NPI:1619201480
Name:JETTON, LAUREN LOVING HIX (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LOVING HIX
Last Name:JETTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:LOVING HIX
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:8912 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6660
Mailing Address - Country:US
Mailing Address - Phone:704-544-5353
Mailing Address - Fax:704-544-5353
Practice Address - Street 1:8912 BLAKENEY PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6660
Practice Address - Country:US
Practice Address - Phone:704-544-5353
Practice Address - Fax:704-544-5382
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor