Provider Demographics
NPI:1699194035
Name:COSTON, ALAN JR (DC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:COSTON
Suffix:JR
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 1:801 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:517-676-3117
Practice Address - Fax:517-676-0704
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010201111N00000X
SC4044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor