MEDICARE: ALAN COSTON JR. 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	2301010201	MI

General Provider Information

NPI Number	:	1699194035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN COSTON JR. D.C.

Provider Business Mailing Address
First Line	:	801 N CEDAR RD
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-9572
Country	:	US
Telephone Number	:	517-676-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 N CEDAR RD
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-9572
Country	:	US
Telephone Number	:	517-676-3117
Fax Number	:	517-676-0704

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	10/24/2018

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