Provider Demographics
NPI:1760712046
Name:LANE CHIROPRACTIC & ACUPUNCTURE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:LANE CHIROPRACTIC & ACUPUNCTURE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-438-3330
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-1368
Mailing Address - Country:US
Mailing Address - Phone:660-438-3330
Mailing Address - Fax:660-438-2222
Practice Address - Street 1:185 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-6047
Practice Address - Country:US
Practice Address - Phone:660-438-3330
Practice Address - Fax:660-438-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0976602OtherMEDICARE
KYV01640Medicare UPIN