Provider Demographics
NPI:1336446897
Name:JERICO, LLC
Entity Type:Organization
Organization Name:JERICO, LLC
Other - Org Name:AAA HEALTHCARE / ALIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERILYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VOGELSANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-304-0757
Mailing Address - Street 1:134 OAK FOREST RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6148
Mailing Address - Country:US
Mailing Address - Phone:843-304-0757
Mailing Address - Fax:
Practice Address - Street 1:134 OAK FOREST RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6148
Practice Address - Country:US
Practice Address - Phone:843-304-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty