Healthcare Provider Details

I. General information

NPI: 1881308419
Provider Name (Legal Business Name): LORELI ESCOLERO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 PARK AVE N
TIFTON GA
31794-4322
US

IV. Provider business mailing address

606 PARK AVE N
TIFTON GA
31794-4322
US

V. Phone/Fax

Practice location:
  • Phone: 229-278-2296
  • Fax: 229-239-9909
Mailing address:
  • Phone: 229-278-2296
  • Fax: 229-239-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR066555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: