Provider Demographics
NPI:1205617636
Name:PORTER, COURTNEY MICHELE (DC, MS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELE
Last Name:PORTER
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2235
Mailing Address - Country:US
Mailing Address - Phone:206-818-7011
Mailing Address - Fax:
Practice Address - Street 1:2513 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5574
Practice Address - Country:US
Practice Address - Phone:425-786-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61490985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor