Provider Demographics
NPI:1396765483
Name:COSTELLO-WOLF, JANET M (DC)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:COSTELLO-WOLF
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 1:6 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1101
Mailing Address - Country:US
Mailing Address - Phone:215-862-1400
Mailing Address - Fax:215-862-6851
Practice Address - Street 1:14 MARKET PL
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1059
Practice Address - Country:US
Practice Address - Phone:215-862-1400
Practice Address - Fax:215-862-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006510L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor