Provider Demographics
NPI:1457240426
Name:LANE, JASON (LAC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 PARKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6679
Mailing Address - Country:US
Mailing Address - Phone:916-847-1692
Mailing Address - Fax:
Practice Address - Street 1:1891 E ROSEVILLE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7973
Practice Address - Country:US
Practice Address - Phone:916-847-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist