Healthcare Provider Details

I. General information

NPI: 1396765483
Provider Name (Legal Business Name): JANET M COSTELLO-WOLF D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MARKET PL
NEW HOPE PA
18938-1059
US

IV. Provider business mailing address

6 MIDDLE RD
NEW HOPE PA
18938-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-862-1400
  • Fax: 215-862-6851
Mailing address:
  • Phone: 215-862-1400
  • Fax: 215-862-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006510L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: