Provider Demographics
NPI:1477973030
Name:COSTON CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:COSTON CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:517-676-3117
Mailing Address - Street 1:801 N CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9572
Mailing Address - Country:US
Mailing Address - Phone:517-676-3117
Mailing Address - Fax:
Practice Address - Street 1:801 N CEDAR RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9572
Practice Address - Country:US
Practice Address - Phone:517-526-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty