Provider Demographics
NPI:1780914655
Name:D'AGOSTINO, LOUIS (DC)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:
Last Name:D'AGOSTINO
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 1:220 MONMOUTH RD
Mailing Address - Street 2:SUITE 1 RIGHT
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1561
Mailing Address - Country:US
Mailing Address - Phone:732-695-6200
Mailing Address - Fax:732-695-6201
Practice Address - Street 1:220 MONMOUTH RD
Practice Address - Street 2:SUITE 1 RIGHT
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1561
Practice Address - Country:US
Practice Address - Phone:732-695-6200
Practice Address - Fax:732-695-6201
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00679100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00679100OtherNJ STATE LICENSE