MEDICARE: DR. DOMINIC STEPHEN LASCOLA 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	038-010620	IL

General Provider Information

NPI Number	:	1720011760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC STEPHEN LASCOLA D.C.

Provider Business Mailing Address
First Line	:	6100 111TH ST
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2105
Country	:	US
Telephone Number	:	708-422-9600
Fax Number	:	708-422-9612

Provider Business Practice Location Address
First Line	:	6100 111TH ST
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2105
Country	:	US
Telephone Number	:	708-422-9600
Fax Number	:	708-422-9612

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/03/2025

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