Provider Demographics
NPI:1710059134
Name:TOUCHET, JEFFERY DALE II (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DALE
Last Name:TOUCHET
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11134 BROAD RIVER RD
Mailing Address - Street 2:STE C
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7616
Mailing Address - Country:US
Mailing Address - Phone:803-781-0031
Mailing Address - Fax:803-781-0032
Practice Address - Street 1:11134 BROAD RIVER RD
Practice Address - Street 2:STE C
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7616
Practice Address - Country:US
Practice Address - Phone:803-781-0031
Practice Address - Fax:803-781-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU950589522Medicare UPIN