Healthcare Provider Details

I. General information

NPI: 1982427522
Provider Name (Legal Business Name): JENNIFER LO CASTO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 COBB PKWY S STE 190
MARIETTA GA
30060-6500
US

IV. Provider business mailing address

3366 STONEWALL DR NW
KENNESAW GA
30152-6512
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-7387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: