Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4065 | SC |
Y | 111NN1001X | Nutrition | 4065 | SC |
NPI | 1194279075 |
---|---|
Provider Name | Dr. Jonathan Kevin Sharpe |
First Address | Mauldin, SC 29662-1873 |
Second Address | Greenville, SC 29615-4254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 09/08/2016 |