Basic Information
| Provider Information | |||||||||
| NPI: | 1225231905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | BRENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2632 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290712632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037414234 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2627 MILLWOOD AVE STE C | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292051273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032189886 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 01/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 3199 | SC | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | GK069Z | 01 | FL | MEDICARE PTAN | OTHER | CH3199 | 05 | SC | MEDICAID | 220N9 | 01 | FL | BCBSFL PROVIDER | OTHER | 11798381 | 01 | OH | CAQH | OTHER | 304526 | 01 | SC | UNISON | OTHER | 000000523023 | 01 | SC | BCBS STATE CREDENTIAL | OTHER | AA27709576 | 01 | SC | MEDICARE PTAN | OTHER |