Provider Demographics
NPI:1447213319
Name:LANE, BRIAN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
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 1:6126 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3026
Mailing Address - Country:US
Mailing Address - Phone:269-383-2444
Mailing Address - Fax:269-383-2451
Practice Address - Street 1:6126 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3026
Practice Address - Country:US
Practice Address - Phone:269-383-2444
Practice Address - Fax:269-383-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950C911950OtherBLUE CROSS BLUE SHIELD
MI0N65040Medicare ID - Type Unspecified