Provider Demographics
NPI:1487600755
Name:LOSAGIO CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:LOSAGIO CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOSAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-865-8155
Mailing Address - Street 1:1220 ILLICKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3654
Mailing Address - Country:US
Mailing Address - Phone:610-865-8155
Mailing Address - Fax:610-758-8998
Practice Address - Street 1:1220 ILLICKS MILL RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3654
Practice Address - Country:US
Practice Address - Phone:610-865-8155
Practice Address - Fax:610-758-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADCOO3864L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA189832Medicare PIN