Provider Demographics
NPI:1093347452
Name:PRINCE, COURTNEY DIANE (DC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DIANE
Last Name:PRINCE
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 1:2757 E SOUTHLAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8015
Mailing Address - Country:US
Mailing Address - Phone:682-688-5534
Mailing Address - Fax:682-688-5549
Practice Address - Street 1:2757 E SOUTHLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8015
Practice Address - Country:US
Practice Address - Phone:682-688-5534
Practice Address - Fax:682-688-5549
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor