MEDICARE: COURTNEY MICHELLE BYNUM

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	:	1184999419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTNEY MICHELLE BYNUM

Provider Business Mailing Address
First Line	:	1011 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-3261
Country	:	US
Telephone Number	:	903-572-1128
Fax Number	:	903-572-1138

Provider Business Practice Location Address
First Line	:	1011 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-3261
Country	:	US
Telephone Number	:	903-572-1128
Fax Number	:	903-572-1138

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY MICHELLE DURRUM
Credential	:	DC
Telephone Number	:	903-572-1128

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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Directions to “COURTNEY MICHELLE BYNUM ” Practice Location

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