MEDICARE: JACK LOCASCIO D.C.

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	5170	TX

General Provider Information

NPI Number	:	1558441501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK LOCASCIO D.C.

Provider Business Mailing Address
First Line	:	433 W 12TH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6507
Country	:	US
Telephone Number	:	214-943-7799
Fax Number	:	214-975-2793

Provider Business Practice Location Address
First Line	:	433 W 12TH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6507
Country	:	US
Telephone Number	:	214-943-7799
Fax Number	:	214-975-2793

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/18/2021

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Directions to “ JACK LOCASCIO D.C.” Practice Location

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