Provider Demographics
NPI:1467452409
Name:INFINGER-COOPER, CAROLINE TENNILLE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:TENNILLE
Last Name:INFINGER-COOPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 GRANDE COVE RD
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29018-9675
Mailing Address - Country:US
Mailing Address - Phone:803-534-7100
Mailing Address - Fax:803-534-7184
Practice Address - Street 1:1170 BOULEVARD ST
Practice Address - Street 2:SUITE E
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4359
Practice Address - Country:US
Practice Address - Phone:800-353-4710
Practice Address - Fax:803-534-7184
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor