Provider Demographics
NPI:1265606511
Name:LO, YA-LING
Entity type:Individual
Prefix:
First Name:YA-LING
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HAZARD AVE STE C7
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4587
Mailing Address - Country:US
Mailing Address - Phone:860-749-4148
Mailing Address - Fax:860-749-4241
Practice Address - Street 1:150 HAZARD AVE STE C7
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4587
Practice Address - Country:US
Practice Address - Phone:860-749-4148
Practice Address - Fax:860-749-4241
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400030993OtherPTAN