Provider Demographics
NPI:1124145180
Name:CARILLO, LINCOLN ESGUERRA (DC)
Entity type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:ESGUERRA
Last Name:CARILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 SUNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3932
Mailing Address - Country:US
Mailing Address - Phone:714-616-4757
Mailing Address - Fax:
Practice Address - Street 1:7601 LITTLE RIVER TPKE
Practice Address - Street 2:#100
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2601
Practice Address - Country:US
Practice Address - Phone:703-642-1004
Practice Address - Fax:703-642-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23418111N00000X
VA0104556819111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA232549ZBSMOtherMEDICARE PTAN