Provider Demographics
NPI:1962597450
Name:COSTA, STEVEN ROBERT (DC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ROBERT
Last Name:COSTA
Suffix:
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 1:4914 FAYETTEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358
Mailing Address - Country:US
Mailing Address - Phone:910-738-3600
Mailing Address - Fax:910-671-9385
Practice Address - Street 1:4914 FAYETTEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-738-3600
Practice Address - Fax:910-671-9385
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0829BMedicaid
NC89-0829BMedicaid
NC2446574AMedicare ID - Type Unspecified