Provider Demographics
NPI:1821327529
Name:VANACKER, COURTNEY S (DC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:VANACKER
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 1:1012 MARKET STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:803-370-4294
Mailing Address - Fax:
Practice Address - Street 1:1012 MARKET STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-370-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4003111N00000X
SC3702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor