MEDICARE: DR. STEPHEN JOSEPH COSTANTINO 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	2002032139	MO

General Provider Information

NPI Number	:	1437193935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JOSEPH COSTANTINO D.C.

Provider Business Mailing Address
First Line	:	909 PURDUE AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3012
Country	:	US
Telephone Number	:	314-862-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 PURDUE AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-3012
Country	:	US
Telephone Number	:	314-862-0101
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	03/08/2017

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