Provider Demographics
NPI:1922354034
Name:HARDEN-VENABLE, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:HARDEN-VENABLE
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 1:3071 HIGHWAY 21 BYP
Mailing Address - Street 2:STE 103
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3071 HIGHWAY 21 BYP
Practice Address - Street 2:STE 103
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7205
Practice Address - Country:US
Practice Address - Phone:704-907-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4290111N00000X
SC3730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor