Active NPI
Ian Joseph Costello
- Chiropractor
- Fairbanks, AK
National Provider Identifier
1912690355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 204821
- Practice address
- 4001 Geist Rd
Fairbanks, AK 99709-3569 - Phone
- (907) 374-1981
- Fax
- (907) 331-0440
- NPI assigned
- May 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 204821 | AK | Primary |
Addresses
Primary practice location
4001 Geist Rd
Fairbanks, AK 99709-3569
Mailing address
4001 Geist Rd
Fairbanks, AK 99709-3569
Phone (907) 374-1981
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685491200000",
"number": "1912690355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 GEIST RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093569",
"telephone_number": "907-374-1981",
"fax_number": "907-331-0440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 GEIST RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997093569",
"telephone_number": "907-374-1981",
"fax_number": "907-331-0440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSTELLO",
"first_name": "IAN",
"middle_name": "JOSEPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-31",
"last_updated": "2023-05-31",
"certification_date": "2023-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AK",
"license": "204821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.