Healthcare Provider Details

I. General information

NPI: 1053472167
Provider Name (Legal Business Name): MICHAEL L COON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 FOLLY RD
CHARLESTON SC
29412
US

IV. Provider business mailing address

PO BOX 12999
CHARLESTON SC
29422
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-3056
  • Fax: 843-762-2488
Mailing address:
  • Phone: 843-972-0227
  • Fax: 843-972-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0928
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: