Provider Demographics
NPI:1356481147
Name:PILLA, CARLO J (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:J
Last Name:PILLA
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 1:5422 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-3320
Mailing Address - Country:US
Mailing Address - Phone:757-894-4529
Mailing Address - Fax:
Practice Address - Street 1:5422 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3320
Practice Address - Country:US
Practice Address - Phone:757-894-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor