Provider Demographics
NPI:1023036233
Name:PORTER, JENNIFER LOVETT (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOVETT
Last Name:PORTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MORNINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9652
Mailing Address - Country:US
Mailing Address - Phone:803-727-4518
Mailing Address - Fax:
Practice Address - Street 1:1 CECIL LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8008
Practice Address - Country:US
Practice Address - Phone:803-808-0440
Practice Address - Fax:803-808-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCV06555Medicare UPIN
SCAA10860281Medicare ID - Type Unspecified