Provider Demographics
NPI:1629037825
Name:LOSAGIO, MARK D (DC,DIBCN)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:LOSAGIO
Suffix:
Gender:M
Credentials:DC,DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 ILLICKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-3654
Mailing Address - Country:US
Mailing Address - Phone:610-865-8155
Mailing Address - Fax:610-758-8998
Practice Address - Street 1:1220 ILLICKS MILL RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3654
Practice Address - Country:US
Practice Address - Phone:610-865-8155
Practice Address - Fax:610-758-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003864L111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011539800002Medicaid
PA547201Medicare ID - Type UnspecifiedCHIROPRACTOR