Provider Demographics
NPI:1346599198
Name:COOMER, SHAYLA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:MARIE
Last Name:COOMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHAYAL
Other - Middle Name:MARIE
Other - Last Name:LESHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1317 LONG GROVE DR D
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9463
Mailing Address - Country:US
Mailing Address - Phone:843-971-1000
Mailing Address - Fax:
Practice Address - Street 1:1317 LONG GROVE DR D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9463
Practice Address - Country:US
Practice Address - Phone:843-971-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3671111N00000X
NC4315111N00000X
FL11555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA99258433Medicare UPIN
FLIF820ZMedicare UPIN