Provider Demographics
NPI:1083788749
Name:LANE, GARRETT SETH (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:SETH
Last Name:LANE
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 1:3607 E BELL RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2152
Mailing Address - Country:US
Mailing Address - Phone:602-569-5656
Mailing Address - Fax:602-569-6119
Practice Address - Street 1:3607 E BELL RD
Practice Address - Street 2:SUITE 7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2152
Practice Address - Country:US
Practice Address - Phone:602-569-5656
Practice Address - Fax:602-569-6119
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871857Medicaid
AZ871857Medicaid