Provider Demographics
NPI:1558884254
Name:JCK HOLDINGS LLC
Entity Type:Organization
Organization Name:JCK HOLDINGS LLC
Other - Org Name:SQUARE ONE RESTORATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-219-5926
Mailing Address - Street 1:2270 SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2331
Mailing Address - Country:US
Mailing Address - Phone:865-219-5926
Mailing Address - Fax:865-951-2972
Practice Address - Street 1:2270 SUTHERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-219-5926
Practice Address - Fax:865-951-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty