NPIMap

Organization Active NPI

Advanced Medical Associates of Summerville

  • Chiropractor
  • Summerville, SC
National Provider Identifier
1790748150
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1243 Issued in SC
Legal business name
ADVANCED MEDICAL ASSOCIATES OF SUMMERVILLE
Practice address
1711 N Main St
Summerville, SC 29483-7807
Phone
(843) 875-2268
Fax
(843) 875-2267
NPI assigned
Apr 7, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Jon Lloyd Etheridge, DCNPI 1043274707
Title
President
Phone
(843) 875-2268

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 1243 SC Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 15987 SC
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 5123 SC

Addresses

Primary practice location

1711 N Main St
Summerville, SC 29483-7807

Mailing address

1711 N Main St
Summerville, SC 29483-7807
Phone (843) 875-2268

National Provider Directory

National Provider Directory

Locations

1055 N Main St
Ste 8
Summerville, SC 29483

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1790748150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 N MAIN ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294837807",
            "telephone_number": "843-875-2268",
            "fax_number": "843-875-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 N MAIN ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294837807",
            "telephone_number": "843-875-2268",
            "fax_number": "843-875-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL ASSOCIATES OF SUMMERVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "ETHERIDGE",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "LLOYD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-875-2268",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "1243",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "SC",
            "license": "15987",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.