MEDICARE: MARK COLEMAN SHIRLEY D.C.

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	:	1619926995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK COLEMAN SHIRLEY D.C.

Provider Business Mailing Address
First Line	:	612 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5120
Country	:	US
Telephone Number	:	803-772-7626
Fax Number	:	803-772-7659

Provider Business Practice Location Address
First Line	:	612 SAINT ANDREWS RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5120
Country	:	US
Telephone Number	:	803-772-7626
Fax Number	:	803-772-7659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK COLEMAN SHIRLEY D.C.” Practice Location

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