Provider Demographics
NPI:1902834831
Name:COSTA, FRANK JR (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:COSTA
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 1:512 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2562
Mailing Address - Country:US
Mailing Address - Phone:732-295-4900
Mailing Address - Fax:732-295-8877
Practice Address - Street 1:512 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2562
Practice Address - Country:US
Practice Address - Phone:732-295-4900
Practice Address - Fax:732-295-8877
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00490200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66058Medicare UPIN
NJ904487Medicare ID - Type Unspecified