Provider Demographics
NPI:1346214566
Name:GRILLO, LORI ANN (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:GRILLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:442 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOHENWALD
Mailing Address - State:TN
Mailing Address - Zip Code:38462-2605
Mailing Address - Country:US
Mailing Address - Phone:931-796-2565
Mailing Address - Fax:931-796-2566
Practice Address - Street 1:442 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-2605
Practice Address - Country:US
Practice Address - Phone:931-796-2565
Practice Address - Fax:931-796-2566
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3679474Medicaid
TN641668OtherUNITED HEALTHCARE
TN4111606OtherBLUE CROSS BLUE SHIELD
TNU70663Medicare UPIN
TN3679474Medicaid