Provider Demographics
NPI:1316129851
Name:BOSTJANCIC, COURTNEY ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ANNE
Last Name:BOSTJANCIC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANNE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 RIVERWALK BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-5071
Mailing Address - Country:US
Mailing Address - Phone:843-252-0533
Mailing Address - Fax:
Practice Address - Street 1:61 RIVERWALK BLVD STE J
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5071
Practice Address - Country:US
Practice Address - Phone:206-498-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034839111N00000X
CADC-30754111N00000X
SC4878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor