Active NPI
Chucky Sentell Jordan, D.C.
- Chiropractor
- Lake City, SC
National Provider Identifier
1841656527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- SC 4099
- Practice address
- 263 Kelley St Ste 100
Lake City, SC 29560-2472 - Phone
- (843) 394-8274
- NPI assigned
- Jan 11, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | SC 4099 | SC | Primary |
Addresses
Primary practice location
263 Kelley St Ste 100
Lake City, SC 29560-2472
Mailing address
542 Ben Gause Rd
Coward, SC 29530-5127
Phone (843) 940-0687
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160318001683 | SC | Practitioner - Chiropractic | 4688971658 |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2015
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1800 2ND Loop Rd
Suite 8
Florence, SC 29501-6180
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4099 | SC | MD | Audiologist-Hearing Aid Fitter |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452470400000",
"number": "1841656527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "542 BEN GAUSE RD",
"city": "COWARD",
"state": "SC",
"postal_code": "295305127",
"telephone_number": "843-940-0687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "263 KELLEY ST STE 100",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295602472",
"telephone_number": "843-394-8274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "CHUCKY",
"middle_name": "SENTELL",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-01-11",
"last_updated": "2016-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "SC",
"license": "SC 4099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; 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.