Provider Demographics
NPI:1720213515
Name:COSTALES, KATHERINE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:COSTALES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:ONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:22833 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021
Mailing Address - Country:US
Mailing Address - Phone:925-949-5815
Mailing Address - Fax:281-894-2890
Practice Address - Street 1:22833 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:925-949-5815
Practice Address - Fax:281-894-2890
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60567596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor