Provider Demographics
NPI:1801077789
Name:YANNI D. LOLI D.C.P.C.
Entity type:Organization
Organization Name:YANNI D. LOLI D.C.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YANNI
Authorized Official - Middle Name:DIMITRI
Authorized Official - Last Name:LOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-892-4101
Mailing Address - Street 1:3934 UNION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4321
Mailing Address - Country:US
Mailing Address - Phone:314-892-4101
Mailing Address - Fax:314-892-4120
Practice Address - Street 1:3934 UNION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4321
Practice Address - Country:US
Practice Address - Phone:314-892-4101
Practice Address - Fax:314-892-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV 10976Medicare UPIN