Provider Demographics
NPI:1083972871
Name:LO BOSCO, LORETO (DC)
Entity Type:Individual
Prefix:DR
First Name:LORETO
Middle Name:
Last Name:LO BOSCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W DUNDEE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3500
Mailing Address - Country:US
Mailing Address - Phone:847-305-1343
Mailing Address - Fax:847-520-0500
Practice Address - Street 1:355 W DUNDEE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-305-1343
Practice Address - Fax:847-520-0500
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32297111N00000X
IL038012359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor