Healthcare Provider Details

I. General information

NPI: 1326166422
Provider Name (Legal Business Name): LORI E CARRILLO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 RIVERSIDE DR
OMAK WA
98841
US

IV. Provider business mailing address

PO BOX 686
OMAK WA
98841-0686
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-3747
  • Fax: 509-826-0113
Mailing address:
  • Phone: 509-826-3747
  • Fax: 509-826-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00003101
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH00003101
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: