Provider Demographics
NPI:1093192841
Name:LORI E. CARRILLO, DC PS INC
Entity Type:Organization
Organization Name:LORI E. CARRILLO, DC PS INC
Other - Org Name:SUNSET CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-826-3747
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0686
Mailing Address - Country:US
Mailing Address - Phone:509-826-3747
Mailing Address - Fax:509-826-0113
Practice Address - Street 1:528 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-826-3747
Practice Address - Fax:509-826-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003101261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center