Provider Demographics
NPI:1861601544
Name:JACK S. LOCASCIO, D.C.,P.C.
Entity type:Organization
Organization Name:JACK S. LOCASCIO, D.C.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOCASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-943-7799
Mailing Address - Street 1:433 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6507
Mailing Address - Country:US
Mailing Address - Phone:214-943-7799
Mailing Address - Fax:214-946-6923
Practice Address - Street 1:433 W 12TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6507
Practice Address - Country:US
Practice Address - Phone:214-943-7799
Practice Address - Fax:214-946-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029NROtherBCBS GROUP