Provider Demographics
NPI:1467727867
Name:LANE, MATTHEW MILLER (DC, MS, CSCS, ART)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MILLER
Last Name:LANE
Suffix:
Gender:M
Credentials:DC, MS, CSCS, ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22346 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3560
Mailing Address - Country:US
Mailing Address - Phone:913-745-4064
Mailing Address - Fax:913-745-4352
Practice Address - Street 1:22346 W 66TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3560
Practice Address - Country:US
Practice Address - Phone:913-745-4064
Practice Address - Fax:913-745-4342
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor