Provider Demographics
NPI:1689817140
Name:COSTA, DAVID DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DANIEL
Last Name:COSTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24B SANDWICH RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1628
Mailing Address - Country:US
Mailing Address - Phone:508-291-6119
Mailing Address - Fax:508-984-8102
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2112
Practice Address - Country:US
Practice Address - Phone:508-291-6119
Practice Address - Fax:508-291-7119
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor