Provider Demographics
NPI:1740617489
Name:LANE CHIROPRACTIC & SPORTS PERFORMANCE
Entity Type:Organization
Organization Name:LANE CHIROPRACTIC & SPORTS PERFORMANCE
Other - Org Name:ACTIVE CHIROCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-525-9013
Mailing Address - Street 1:1245 LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512
Mailing Address - Country:US
Mailing Address - Phone:402-323-7838
Mailing Address - Fax:
Practice Address - Street 1:1245 LIBRA DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9707
Practice Address - Country:US
Practice Address - Phone:402-323-7838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1407100324OtherINDIVIDUAL NPI