Provider Demographics
NPI:1417193442
Name:ACOSTA, ELIZABETH M (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NUTMEG PL STE 110
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2557
Mailing Address - Country:US
Mailing Address - Phone:714-751-8110
Mailing Address - Fax:714-437-9764
Practice Address - Street 1:1520 NUTMEG PL STE 110
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2557
Practice Address - Country:US
Practice Address - Phone:714-751-8110
Practice Address - Fax:714-437-9764
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor