Provider Demographics
NPI:1356769152
Name:GOWIN, COURTNEY (DC)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:GOWIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:LAING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4811 BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6504
Mailing Address - Country:US
Mailing Address - Phone:469-249-2623
Mailing Address - Fax:469-453-3336
Practice Address - Street 1:4811 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6504
Practice Address - Country:US
Practice Address - Phone:469-249-2623
Practice Address - Fax:469-453-3336
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor