Provider Demographics
NPI:1447296165
Name:COURSON, MICHAEL M (BBA, DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:COURSON
Suffix:
Gender:M
Credentials:BBA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 S MORGANS POINT RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8331
Mailing Address - Country:US
Mailing Address - Phone:843-971-8814
Mailing Address - Fax:843-971-1933
Practice Address - Street 1:3373 S MORGANS POINT RD
Practice Address - Street 2:SUITE 307
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8331
Practice Address - Country:US
Practice Address - Phone:843-971-8814
Practice Address - Fax:843-971-1933
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2533111NR0200X, 111NR0400X, 111NP0017X, 111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2533Medicaid