MEDICARE: MARY ELIZABETH LAGASCA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH12525	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184193823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH LAGASCA DC

Provider Business Mailing Address
First Line	:	11211 PROSPERITY FARMS RD STE B104
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3453
Country	:	US
Telephone Number	:	561-537-4526
Fax Number	:

Provider Business Practice Location Address
First Line	:	4723 W ATLANTIC AVE STE 19
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3865
Country	:	US
Telephone Number	:	561-277-2369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2018
Last Update Date	:	06/12/2019

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