Individual provider Active NPI

Jeremiah J. Jimerson, D.C.

  • Chiropractor
  • Charleston, SC
National Provider Identifier
1558302869
Registry record updated Aug 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3131 Issued in SC
Practice address
761 Saint Andrews Blvd
Charleston, SC 29407-7164
Phone
(843) 873-6004
Fax
(843) 766-3694
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3131 SC Primary

Addresses

Primary practice location

761 Saint Andrews Blvd
Charleston, SC 29407-7164

Mailing address

761 Saint Andrews Blvd
Charleston, SC 29407-7164
Phone (843) 873-6004

Other identifiers 1

IdentifierTypeStateIssuer
3131OtherSCLICENSE/CHIROPRACTOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070221000001 SC Practitioner - Chiropractic 4486690245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

761 Saint Andrews Blvd
Charleston, SC 29407-7164
Phone (843) 867-7334

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X011070-1NYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Stoller Enterprise Chiropractor PastSince Dec 1, 2019 Accepting new patients
Munroe Chiropractic Chiropractor PastSince Nov 1, 2000 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1558302869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077164",
            "telephone_number": "843-873-6004",
            "fax_number": "843-766-3694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 SAINT ANDREWS BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294077164",
            "telephone_number": "843-873-6004",
            "fax_number": "843-766-3694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMERSON",
        "first_name": "JEREMIAH",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE/CHIROPRACTOR",
            "identifier": "3131",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.