Provider Demographics
NPI:1881686947
Name:JETER, ANDREW S (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:JETER
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 1:68 GLOBAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4628
Mailing Address - Country:US
Mailing Address - Phone:864-644-2700
Mailing Address - Fax:864-644-2709
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3612
Practice Address - Country:US
Practice Address - Phone:704-633-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844NMedicaid
NC890844NMedicaid