Provider Demographics
NPI:1174873046
Name:JCJ WHOLISTIC HEALTH CARE, LLC
Entity type:Organization
Organization Name:JCJ WHOLISTIC HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:313-408-0498
Mailing Address - Street 1:19800 HAZELHURST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7307
Mailing Address - Country:US
Mailing Address - Phone:313-408-0498
Mailing Address - Fax:888-900-1093
Practice Address - Street 1:18451 HEYDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3410
Practice Address - Country:US
Practice Address - Phone:313-408-0498
Practice Address - Fax:888-900-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBUS2012-00404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty