Provider Demographics
NPI:1437428174
Name:DICKINSON, COURTNEY BROOKE (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:BROOKE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:BROOKE
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2207 RIVA ROW
Mailing Address - Street 2:# 3406
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3134
Mailing Address - Country:US
Mailing Address - Phone:713-516-5147
Mailing Address - Fax:
Practice Address - Street 1:2207 RIVA ROW
Practice Address - Street 2:# 3406
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3134
Practice Address - Country:US
Practice Address - Phone:713-516-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor