Provider Demographics
NPI:1558441501
Name:LOCASCIO, JACK (DC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:LOCASCIO
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 1:433 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6507
Mailing Address - Country:US
Mailing Address - Phone:214-943-7799
Mailing Address - Fax:214-975-2793
Practice Address - Street 1:433 W 12TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6507
Practice Address - Country:US
Practice Address - Phone:214-943-7799
Practice Address - Fax:214-975-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor