Tammy Lynne Costello, DC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

SC2755 Issued in SC

Practice address

1151 Robert Grissom Pkwy
Myrtle Beach, SC 29577-5664

Phone

(843) 839-5588

Fax

(843) 839-5591

NPI assigned

Oct 4, 2006

Last updated

May 11, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Enrolled

State licenses

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.

• Life Line Chiropractic

  • Sports Physician Chiropractor
  • Myrtle Beach, SC
  • NPI 1649331380
  Authorized official Same address or phone

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1558456202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 ROBERT GRISSOM PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-839-5588",
            "fax_number": "843-839-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 ROBERT GRISSOM PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775664",
            "telephone_number": "843-839-5588",
            "fax_number": "843-839-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "TAMMY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "SC",
            "license": "SC2755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Sports Physician Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; 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.