Provider Demographics
NPI:1639736465
Name:CALVERT, COURTNEY JEAN (DC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEAN
Last Name:CALVERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JEAN
Other - Last Name:PESTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4613 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7204
Mailing Address - Country:US
Mailing Address - Phone:810-662-4395
Mailing Address - Fax:
Practice Address - Street 1:4613 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7204
Practice Address - Country:US
Practice Address - Phone:810-662-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor