MEDICARE: ELIZABETH M. ACOSTA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC30542	CA

General Provider Information

NPI Number	:	1417193442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M. ACOSTA D.C.

Provider Business Mailing Address
First Line	:	1520 NUTMEG PL STE 110
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2557
Country	:	US
Telephone Number	:	714-751-8110
Fax Number	:	714-437-9764

Provider Business Practice Location Address
First Line	:	1520 NUTMEG PL STE 110
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2557
Country	:	US
Telephone Number	:	714-751-8110
Fax Number	:	714-437-9764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/22/2008

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