Provider Demographics
NPI:1720011760
Name:LASCOLA, DOMINIC STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:STEPHEN
Last Name:LASCOLA
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 1:3613 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2119
Mailing Address - Country:US
Mailing Address - Phone:708-422-9600
Mailing Address - Fax:
Practice Address - Street 1:3613 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2119
Practice Address - Country:US
Practice Address - Phone:708-422-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor