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General NPI Number Information
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NPI Number | 1013998764
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Entity Type | Organization
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Legal Business Name | STEVE J COSTALES CHIROPRACTIC INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 24741 ALICIA PKWY SUITE D
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4613
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Country | US
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Telephone | 949-951-1160
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Fax | 949-951-1107
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Provider Business Mailing Address
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Address Line | 24741 ALICIA PKWY SUITE D
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-4613
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Country | US
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Telephone | 949-951-1160
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Fax | 949-951-1107
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. STEVE JON COSTALES
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Credential | DC MS ATC
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Telephone | 949-951-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC27735
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License Number State | CA
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