Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH00003101 | WA |
N | 111NN1001X | Nutrition | CH00003101 | WA |
NPI | 1326166422 |
---|---|
Provider Name | Lori E Carrillo |
First Address | Omak, WA 98841-0686 |
Second Address | Omak, WA 98841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |