Healthcare Provider Details

I. General information

NPI: 1730891912
Provider Name (Legal Business Name): ALEXANDER LEE COSTELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 WASHINGTON RD STE SF
PITTSBURGH PA
15228-1901
US

IV. Provider business mailing address

615 WASHINGTON RD STE SF
PITTSBURGH PA
15228-1901
US

V. Phone/Fax

Practice location:
  • Phone: 412-344-9940
  • Fax:
Mailing address:
  • Phone: 412-344-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011704
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: