Provider Demographics
NPI:1124272752
Name:RALPH JIM MINICO COMPANY
Entity type:Organization
Organization Name:RALPH JIM MINICO COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:MINICO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:803-932-9399
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:803-948-9322
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:803-948-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU230190282Medicare UPIN