Provider Demographics
NPI:1225116338
Name:LANE, JUDY F (DC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:F
Last Name:LANE
Suffix:
Gender:F
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:PO BOX 8188
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8188
Mailing Address - Country:US
Mailing Address - Phone:818-222-5636
Mailing Address - Fax:818-222-8853
Practice Address - Street 1:22471 SUENO RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2900
Practice Address - Country:US
Practice Address - Phone:818-222-5636
Practice Address - Fax:818-222-8853
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14679111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17857Medicare ID - Type Unspecified
CADC14679Medicare UPIN