Provider Demographics
NPI:1982941316
Name:CARMACK, COURTNEY LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LEIGH
Last Name:CARMACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:301 N SHACKLEFORD RD STE F1
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2887
Mailing Address - Country:US
Mailing Address - Phone:501-515-4117
Mailing Address - Fax:
Practice Address - Street 1:301 N SHACKLEFORD RD STE F1
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2887
Practice Address - Country:US
Practice Address - Phone:501-217-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor