Provider Demographics
NPI:1033616545
Name:BROSIOUS, COURTNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:BROSIOUS
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 1:715 W BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3003
Mailing Address - Country:US
Mailing Address - Phone:570-788-3737
Mailing Address - Fax:
Practice Address - Street 1:715 W BUTLER DR
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3003
Practice Address - Country:US
Practice Address - Phone:570-788-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor