Provider Demographics
NPI:1760424857
Name:COURTNEY, M D (DC)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:D
Last Name:COURTNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5621
Mailing Address - Country:US
Mailing Address - Phone:870-534-1231
Mailing Address - Fax:870-534-3945
Practice Address - Street 1:1421 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5621
Practice Address - Country:US
Practice Address - Phone:870-534-1231
Practice Address - Fax:870-534-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
59127Medicare PIN
AR59127B287Medicare PIN