Provider Demographics
NPI:1033983457
Name:KOSTZER, KOURTNEY (DC)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:KOSTZER
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 1:3885 SPALDING BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2306
Mailing Address - Country:US
Mailing Address - Phone:954-798-3674
Mailing Address - Fax:
Practice Address - Street 1:1180 SAMPLES INDUSTRIAL DR STE D
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-0205
Practice Address - Country:US
Practice Address - Phone:470-820-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor