MEDICARE: COURTHOUSE CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1235602426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTHOUSE CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1811 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	GLOUCESTER POINT
State	:	VA
Zip	:	23062-2220
Country	:	US
Telephone Number	:	804-684-5196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 GEORGE WASHINGTON MEMORIAL HWY
Second Line	:
City	:	GLOUCESTER POINT
State	:	VA
Zip	:	23062-2220
Country	:	US
Telephone Number	:	757-202-2960
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MICHAEL TISO
Credential	:	DC
Telephone Number	:	804-684-5196

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	09/19/2024

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