Provider Demographics
NPI:1043876741
Name:CCSJ, HOLDINGS, LLC
Entity Type:Organization
Organization Name:CCSJ, HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-323-2003
Mailing Address - Street 1:996 BATESVILLE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6825
Mailing Address - Country:US
Mailing Address - Phone:864-605-7544
Mailing Address - Fax:
Practice Address - Street 1:996 BATESVILLE RD STE 7
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6825
Practice Address - Country:US
Practice Address - Phone:864-605-7544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty