Provider Demographics
NPI:1558452235
Name:KING, LANA MARTINI (DC)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:MARTINI
Last Name:KING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LANA
Other - Middle Name:RAE
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 2052
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-1252
Mailing Address - Country:US
Mailing Address - Phone:252-537-2425
Mailing Address - Fax:252-537-4809
Practice Address - Street 1:400 BECKER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3171
Practice Address - Country:US
Practice Address - Phone:252-537-2425
Practice Address - Fax:252-537-4809
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0827LOtherBCBS
NC890827LMedicaid
350047443OtherRAILROAD MEDICARE
NC890827LMedicaid
2452818AMedicare PIN