Provider Demographics
NPI:1073603783
Name:STEPHEN J COSTANTINO CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:STEPHEN J COSTANTINO CHIROPRACTIC, PC
Other - Org Name:DELMAR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-477-7473
Mailing Address - Street 1:7171 DELMAR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7171 DELMAR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4334
Practice Address - Country:US
Practice Address - Phone:314-477-7473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty