Provider Demographics
NPI:1932965068
Name:SLACK, COURTNEY ANN (DC, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANN
Last Name:SLACK
Suffix:
Gender:F
Credentials:DC, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:NY
Mailing Address - Zip Code:14836-9640
Mailing Address - Country:US
Mailing Address - Phone:716-307-9592
Mailing Address - Fax:
Practice Address - Street 1:10012 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:NY
Practice Address - Zip Code:14836-9640
Practice Address - Country:US
Practice Address - Phone:716-307-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor