Provider Demographics
NPI:1093780488
Name:LANE, CHRISTOPHER WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILLIAM
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 1:725 E FIGZEL CT
Mailing Address - Street 2:#104
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-2276
Mailing Address - Country:US
Mailing Address - Phone:605-498-5100
Mailing Address - Fax:605-498-5101
Practice Address - Street 1:725 E FIGZEL CT
Practice Address - Street 2:#104
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-2276
Practice Address - Country:US
Practice Address - Phone:605-498-5100
Practice Address - Fax:605-498-5101
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD1023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601930Medicaid
SD7601930Medicaid
SDU99355Medicare UPIN