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General NPI Number Information
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NPI Number | 1215000278
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Entity Type | Organization
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Legal Business Name | SHIRLEY CHIROPRACTIC & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 612 SAINT ANDREWS RD STE 3
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City | COLUMBIA
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State | SC
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Zip | 29210-5120
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Country | US
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Telephone | 803-772-7626
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Fax |
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Provider Business Mailing Address
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Address Line | 612 SAINT ANDREWS RD STE 3
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City | COLUMBIA
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State | SC
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Zip | 29210-5120
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Country | US
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Telephone | 803-772-7626
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MARK SHIRLEY
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Credential | DC
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Telephone | 803-772-7626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2245
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License Number State | SC
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