Individual
DR. DANIEL JESSE COSTA JR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4315 AZALEA DR, SUITE 201, LISLE, IL 60532-1181
(630) 717-8900
Mailing address
PO BOX 592, NAPERVILLE, IL 60566-0592
(630) 717-8900
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BLUECROSSBLUE SHIELD
GROUP # 02221920
IL
Enumeration date
05/03/2007
Last updated
07/08/2007
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