Individual provider Active NPI

Johnathan Charles Davis, D.C.

  • Chiropractor
  • Hartsville, SC
National Provider Identifier
1982843025
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3418 Issued in SC
Practice address
1268 S 4TH St
Hartsville, SC 29550-0703
Phone
(843) 332-3422
Fax
(843) 332-3985
NPI assigned
Feb 12, 2009
Last updated
Apr 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3418 SC Primary

Addresses

Primary practice location

1268 S 4TH St
Hartsville, SC 29550-0703

Mailing address

PO Box 1090
Hartsville, SC 29551-1090
Phone (843) 857-0111

Other practice location 1

122 Latimer St
Latta, SC 29565-1828
Phone (843) 627-6252

Other identifiers 1

IdentifierTypeStateIssuer
CH3418MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090527000510 SC Practitioner - Chiropractic 2466501234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caresouth Carolina Inc.Group PAC ID 1052221314, 66 clinicians

Practice addresses (Care Compare)

1268 S 4TH St
Hartsville, SC 29550-0703
Phone (843) 332-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3418SCMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Caresouth Carolina, Inc. CurrentSince May 4, 2015 Accepting new patients
Caresouth Carolina, Inc Past Accepting new patients
Emily Hanners DC LLC Chiropractor PastSince Jan 10, 2013 Accepting new patients
Caresouth Carolina Inc Past Accepting new patients

Locations

1268 S 4th St
Hartsville, SC 29550
Phone (843) 332-3422

1268 S 4th St
Ste B
Hartsville, SC 29550

122 Latimer St
Latta, SC 29565
Phone (843) 627-6252

3080 Highway 15-401 E
Mc Coll, SC 29570
Phone (843) 523-5751

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1982843025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090",
            "telephone_number": "843-857-0111",
            "fax_number": "843-857-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 S 4TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295500703",
            "telephone_number": "843-332-3422",
            "fax_number": "843-332-3985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 Latimer St",
            "address_purpose": "LOCATION",
            "city": "Latta",
            "state": "SC",
            "postal_code": "295651828",
            "country_code": "US",
            "telephone_number": "843-627-6252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHNATHAN",
        "middle_name": "CHARLES",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-12",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "3418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH3418",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; 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.