Healthcare Provider Details

I. General information

NPI: 1447296165
Provider Name (Legal Business Name): MICHAEL M COURSON BBA, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 S MORGANS POINT RD SUITE 307
MT PLEASANT SC
29466-8331
US

IV. Provider business mailing address

3373 S MORGANS POINT RD SUITE 307
MT PLEASANT SC
29466-8331
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-8814
  • Fax: 843-971-1933
Mailing address:
  • Phone: 843-971-8814
  • Fax: 843-971-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2533
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2533
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2533
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2533
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2533
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: