Individual
BRUCE COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2365 WALL ST SE, SUITE 100, CONYERS, GA 30013-2197
(770) 922-8187
(770) 922-9107
Mailing address
455 RIVERBEND DR, MCDONOUGH, GA 30252-4110
(404) 354-3111
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIR002554
GA
Other
Enumeration date
09/12/2012
Last updated
09/12/2012
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