MEDICARE: SHIRLEY CHIROPRACTIC & WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2245	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215000278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIRLEY CHIROPRACTIC & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	612 SAINT ANDREWS RD STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5120
Country	:	US
Telephone Number	:	803-772-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 SAINT ANDREWS RD STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5120
Country	:	US
Telephone Number	:	803-772-7626
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. MARK SHIRLEY
Credential	:	DC
Telephone Number	:	803-772-7626

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/19/2011

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Directions to “SHIRLEY CHIROPRACTIC & WELLNESS CENTER, LLC ” Practice Location

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