Provider Demographics
NPI:1093146490
Name:ACOSTA, EMILY M (DC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:M
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4708 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-412-6920
Mailing Address - Fax:
Practice Address - Street 1:4040 42ND ST. S
Practice Address - Street 2:SUITE K
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-356-0080
Practice Address - Fax:701-356-0088
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4400111N00000X
ND1010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor