Provider Demographics
NPI:1447283742
Name:AUGELLO, MARK J (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:AUGELLO
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 1:1578 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5911
Mailing Address - Country:US
Mailing Address - Phone:610-866-4440
Mailing Address - Fax:610-866-5671
Practice Address - Street 1:1578 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-5911
Practice Address - Country:US
Practice Address - Phone:610-866-4440
Practice Address - Fax:610-866-5671
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005332-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1425641Medicaid
PA1425641Medicaid
PAAU744145Medicare ID - Type Unspecified