Provider Demographics
NPI:1790878940
Name:COURTLEY CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:COURTLEY CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:COURTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-986-8088
Mailing Address - Street 1:149 KELSEY DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-986-8088
Mailing Address - Fax:865-986-5400
Practice Address - Street 1:149 KELSEY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-986-8088
Practice Address - Fax:865-986-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3044726OtherBLUE CROSS BLUE SHIELD
TN3044726OtherBLUE CROSS BLUE SHIELD