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General NPI Number Information
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NPI Number | 1346451754
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Entity Type | Individual
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Provider Name | MARK COSTELLO L.AC.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2516 W MAIN ST
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City | LITTLETON
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State | CO
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Zip | 80120-1913
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Country | US
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Telephone | 303-797-6656
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Fax | 303-797-6616
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Provider Business Mailing Address
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Address Line | 2516 W MAIN ST
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City | LITTLETON
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State | CO
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Zip | 80120-1913
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Country | US
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Telephone | 303-797-6656
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Fax | 303-797-6616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 361
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License Number State | CO
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