MEDICARE: AMANDA COURTNEY DC

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	CH12132	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750812871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COURTNEY DC

Provider Business Mailing Address
First Line	:	3190 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5741
Country	:	US
Telephone Number	:	386-453-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 SUNTREE BLVD STE 101
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-5741
Country	:	US
Telephone Number	:	321-622-4501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	06/15/2020

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