Provider Demographics
NPI:1396915716
Name:ST JOHN, NANCY S (DC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:S
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ST JOHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:300 E A AVE
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2104
Mailing Address - Country:US
Mailing Address - Phone:864-855-1523
Mailing Address - Fax:864-855-0380
Practice Address - Street 1:300 E A AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2104
Practice Address - Country:US
Practice Address - Phone:864-855-1523
Practice Address - Fax:864-855-0380
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1637111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU346417213Medicare PIN