Provider Demographics
NPI:1427538552
Name:KHALSA, COURTNEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:L
Last Name:KHALSA
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 1:12755 SW 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1816
Mailing Address - Country:US
Mailing Address - Phone:518-578-0106
Mailing Address - Fax:
Practice Address - Street 1:16771 SW 12TH ST STE E
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6024
Practice Address - Country:US
Practice Address - Phone:503-822-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor