Provider Demographics
NPI:1437645629
Name:LANE, AUSTIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:JAMES
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 1:18042 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5603
Mailing Address - Country:US
Mailing Address - Phone:714-962-1674
Mailing Address - Fax:714-964-9624
Practice Address - Street 1:18042 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5603
Practice Address - Country:US
Practice Address - Phone:714-962-1674
Practice Address - Fax:714-964-9624
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34269111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation