Provider Demographics
NPI:1902958648
Name:SHOOKER, CLIFFORD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:MICHAEL
Last Name:SHOOKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 N DONNELLY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2814
Mailing Address - Country:US
Mailing Address - Phone:352-735-4331
Mailing Address - Fax:352-735-2901
Practice Address - Street 1:1416 N DONNELLY ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2814
Practice Address - Country:US
Practice Address - Phone:352-735-4331
Practice Address - Fax:352-735-2901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005590111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22091Medicare ID - Type Unspecified