Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 781 | SC |
NPI | 1003026865 |
---|---|
Provider Name | Dr. Jerry Charles Langley |
First Address | Greenville, SC 29605-4280 |
Second Address | Greenville, SC 29605-4280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 03/03/2017 |