Healthcare Provider Details

I. General information

NPI: 1689764490
Provider Name (Legal Business Name): YANNI DIMITRI LOLI D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 UNION RD
SAINT LOUIS MO
63125-4321
US

IV. Provider business mailing address

3934 UNION RD
SAINT LOUIS MO
63125-4321
US

V. Phone/Fax

Practice location:
  • Phone: 314-892-4101
  • Fax: 314-892-4120
Mailing address:
  • Phone: 314-892-4101
  • Fax: 341-892-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2004029907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: