Bruce Costello, DC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

CHIR002554 Issued in GA

Practice address

2365 Wall St SE
Suite 100
Conyers, GA 30013-2197

Phone

(770) 922-8187

Fax

(770) 922-9107

NPI assigned

Sep 12, 2012

Last updated

Sep 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• MB Costello Enterprises LLC

  dba PCA Pain Care Center

  • Pain Medicine (Anesthesiology) Physician
  • Jackson, MS
  • NPI 1982996567
  Authorized official Same address or phone
• Boscher Enterprises Inc

  dba Conyers Family Chiropractic Center

  • Chiropractor
  • Conyers, GA
  • NPI 1194100370
  NPD (past)
• Proactive Healthcare Solutions, LLC

  • Clinic/Center
  • Conyers, GA
  • NPI 1780958835
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1184974651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 RIVERBEND DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524110",
            "telephone_number": "404-354-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 WALL ST SE",
            "address_2": "SUITE 100",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132197",
            "telephone_number": "770-922-8187",
            "fax_number": "770-922-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "BRUCE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIR002554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lyn Cooper, M.D.
• Taylor Copeland, RBT
• Corinthian Systems LLC
• Cornerstone Caregiving East LLC
• Rosirma Corney, PA-C
• Donald N Cote, MD
• Christopher Blake Couey, PA
• Covenant Consulting and Practice Management Corp (Covenant Care)
• Brigioni Covington, RBT
• Cowan Pharmacy LLC (Conyers Pharmacy)

• Rehabilitation Chiropractor in Conyers, GA
• Providers in Conyers, GA by specialty
• Rehabilitation Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.