Provider Demographics
NPI:1548500531
Name:LO, JERRY YEE-WEN (DC, MS, BS)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:YEE-WEN
Last Name:LO
Suffix:
Gender:M
Credentials:DC, MS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1422
Mailing Address - Country:US
Mailing Address - Phone:217-652-4568
Mailing Address - Fax:
Practice Address - Street 1:2428 MELBOURNE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-1422
Practice Address - Country:US
Practice Address - Phone:217-652-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor