Provider Demographics
NPI:1619284908
Name:TITCOMBE, JENNA LYNNE (DC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNNE
Last Name:TITCOMBE
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 1:4109 E NORTH ST
Mailing Address - Street 2:#600
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6209
Mailing Address - Country:US
Mailing Address - Phone:864-908-7873
Mailing Address - Fax:
Practice Address - Street 1:4109 E NORTH ST
Practice Address - Street 2:#600
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6209
Practice Address - Country:US
Practice Address - Phone:864-908-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60174984111N00000X
IL038011894111N00000X
SCDC.3729 DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor