Provider Demographics
NPI:1598246852
Name:LAW, COURTNEY MARIE (DC)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:MARIE
Last Name:LAW
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 1:209 JACKSTAY CT
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-6137
Mailing Address - Country:US
Mailing Address - Phone:410-868-4351
Mailing Address - Fax:
Practice Address - Street 1:5495 SUNSET BLVD STE B-C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7499
Practice Address - Country:US
Practice Address - Phone:803-490-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor