Healthcare Provider Details

I. General information

NPI: 1235602426
Provider Name (Legal Business Name): COURTHOUSE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER POINT VA
23062-2220
US

IV. Provider business mailing address

1811 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER POINT VA
23062-2220
US

V. Phone/Fax

Practice location:
  • Phone: 757-202-2960
  • Fax:
Mailing address:
  • Phone: 804-684-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL TISO
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 804-684-5196