Provider Demographics
NPI:1851308142
Name:CASTELLO, ALICIA K (DC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:K
Last Name:CASTELLO
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 1:2112 NORTHGLEN DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3046
Mailing Address - Country:US
Mailing Address - Phone:817-456-3222
Mailing Address - Fax:
Practice Address - Street 1:1001 GLADE RD
Practice Address - Street 2:STE 120
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2854
Practice Address - Country:US
Practice Address - Phone:817-427-2777
Practice Address - Fax:817-427-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752830611OtherTAX ID
TX752830611OtherTAX ID
TX609341Medicare ID - Type Unspecified