Provider Demographics
NPI:1013998764
Name:STEVE J COSTALES CHIROPRACTIC INC
Entity Type:Organization
Organization Name:STEVE J COSTALES CHIROPRACTIC INC
Other - Org Name:CHIROPRACTIC SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:JON
Authorized Official - Last Name:COSTALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC MS ATC
Authorized Official - Phone:949-951-1160
Mailing Address - Street 1:24741 ALICIA PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4613
Mailing Address - Country:US
Mailing Address - Phone:949-951-1160
Mailing Address - Fax:949-951-1107
Practice Address - Street 1:24741 ALICIA PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4613
Practice Address - Country:US
Practice Address - Phone:949-951-1160
Practice Address - Fax:949-951-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18889Medicare ID - Type Unspecified
U97297Medicare UPIN