Provider Demographics
NPI:1114290681
Name:CLARKE-FOLIKUMAH, SHANDA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:MARIE
Last Name:CLARKE-FOLIKUMAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHANDA
Other - Middle Name:MARIE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1838 CAPITAL CIRCLE N.E.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-402-9060
Mailing Address - Fax:850-402-9063
Practice Address - Street 1:1838 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4420
Practice Address - Country:US
Practice Address - Phone:850-402-9060
Practice Address - Fax:850-402-9063
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor