Provider Demographics
NPI:1649499781
Name:HARALAMBOUS, JASON S (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:HARALAMBOUS
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 1:3A MARKET # 1
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-9107
Mailing Address - Country:US
Mailing Address - Phone:843-368-6787
Mailing Address - Fax:
Practice Address - Street 1:3A MARKET # 1
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-9107
Practice Address - Country:US
Practice Address - Phone:843-368-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7912Medicare PIN
SCU94725Medicare UPIN