Provider Demographics
NPI:1144039124
Name:LASCOLA WELLNESS LLC
Entity type:Organization
Organization Name:LASCOLA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LASCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-422-9600
Mailing Address - Street 1:6100 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2105
Mailing Address - Country:US
Mailing Address - Phone:708-422-9600
Mailing Address - Fax:708-422-9612
Practice Address - Street 1:6100 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2105
Practice Address - Country:US
Practice Address - Phone:708-422-9600
Practice Address - Fax:708-422-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty