Provider Demographics
NPI:1760848162
Name:BOLEN, COURTNEY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:BOLEN
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 1:651 E M 55
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9238
Mailing Address - Country:US
Mailing Address - Phone:989-984-5100
Mailing Address - Fax:989-305-6419
Practice Address - Street 1:651 E M 55
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9238
Practice Address - Country:US
Practice Address - Phone:989-984-5100
Practice Address - Fax:989-305-6419
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor