Provider Demographics
NPI:1396947842
Name:ROBERT D MASCIO
Entity type:Organization
Organization Name:ROBERT D MASCIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-793-0246
Mailing Address - Street 1:3102 OAK LAWN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4241
Mailing Address - Country:US
Mailing Address - Phone:214-793-0246
Mailing Address - Fax:304-723-4110
Practice Address - Street 1:3102 OAK LAWN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4208
Practice Address - Country:US
Practice Address - Phone:214-793-0246
Practice Address - Fax:304-723-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty