Provider Demographics
NPI:1831597772
Name:CLOUSE CHIROPRACTIC SERVICES LLC
Entity type:Organization
Organization Name:CLOUSE CHIROPRACTIC SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PROVIDOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-761-4470
Mailing Address - Street 1:505 N HIGHWAY 52
Mailing Address - Street 2:SUITE D #127
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3151
Mailing Address - Country:US
Mailing Address - Phone:843-761-4470
Mailing Address - Fax:843-695-7932
Practice Address - Street 1:112 BROUGHTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-4021
Practice Address - Country:US
Practice Address - Phone:843-761-4470
Practice Address - Fax:843-695-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDW2715OtherRAILROAD MEDICARE GROUP PTAN
SCDW2715OtherRAILROAD MEDICARE GROUP PTAN