Provider Demographics
NPI:1265033286
Name:DILLOW, COREY (LAC , LMT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DILLOW
Suffix:
Gender:M
Credentials:LAC , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9110
Mailing Address - Country:US
Mailing Address - Phone:630-930-4035
Mailing Address - Fax:
Practice Address - Street 1:200 GREENLEAVES BLVD STE 11
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7092
Practice Address - Country:US
Practice Address - Phone:630-930-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9196225700000X
LA323918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist