Provider Demographics
NPI:1366484073
Name:COURSON, GINA LYNN (BS,DC)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:LYNN
Last Name:COURSON
Suffix:
Gender:F
Credentials:BS,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?:Yes
Enumeration Date:2006-06-10
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2532Medicaid
SCCH2532Medicaid