Provider Demographics
NPI:1356322671
Name:MINICO, RALPH JIM JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JIM
Last Name:MINICO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 AMICKS FERRY RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8663
Mailing Address - Country:US
Mailing Address - Phone:803-932-9399
Mailing Address - Fax:803-932-9299
Practice Address - Street 1:203 AMICKS FERRY RD
Practice Address - Street 2:SUITE 800
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8663
Practice Address - Country:US
Practice Address - Phone:803-932-9399
Practice Address - Fax:803-932-9299
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2441111N00000X
MI2301006644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU23019Medicare UPIN
SCU230190282Medicare UPIN