Healthcare Provider Details

I. General information

NPI: 1629037825
Provider Name (Legal Business Name): MARK D LOSAGIO DC,DIBCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 ILLICKS MILL RD
BETHLEHEM PA
18017-3654
US

IV. Provider business mailing address

1220 ILLICKS MILL RD
BETHLEHEM PA
18017-3654
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-8155
  • Fax: 610-758-8998
Mailing address:
  • Phone: 610-865-8155
  • Fax: 610-758-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003864L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC003864L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: