Provider Demographics
NPI:1689830135
Name:COSTALES, STEVEN JON (DC, MS, ATC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JON
Last Name:COSTALES
Suffix:
Gender:M
Credentials:DC, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24741 ALICIA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4613
Mailing Address - Country:US
Mailing Address - Phone:949-951-1160
Mailing Address - Fax:949-951-1107
Practice Address - Street 1:24741 ALICIA PKWY STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4613
Practice Address - Country:US
Practice Address - Phone:949-951-1160
Practice Address - Fax:949-951-1107
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC27735AOtherMEDICARE PTAN
CA202613906OtherGROUP NPI
CAW18889OtherMEDICARE GROUP PTAN
CADC27735Medicare PIN
CA202613906OtherGROUP NPI