Provider Demographics
NPI:1730891912
Name:COSTELLO, ALEXANDER LEE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEE
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WASHINGTON RD STE SF
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1901
Mailing Address - Country:US
Mailing Address - Phone:412-344-9940
Mailing Address - Fax:
Practice Address - Street 1:615 WASHINGTON RD STE SF
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1901
Practice Address - Country:US
Practice Address - Phone:412-344-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor