Healthcare Provider Details

I. General information

NPI: 1457479529
Provider Name (Legal Business Name): RONALD O. ACOSTA, D.C. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

IV. Provider business mailing address

2809 MERIDIAN AVE E
EDGEWOOD WA
98371-2108
US

V. Phone/Fax

Practice location:
  • Phone: 253-840-1100
  • Fax: 253-840-1199
Mailing address:
  • Phone: 253-840-1100
  • Fax: 253-840-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH003629
License Number StateWA

VIII. Authorized Official

Name: DR. RONALD OVIDIO ACOSTA
Title or Position: OWNER
Credential: D.C.
Phone: 253-840-1100