Provider Demographics
NPI:1780834937
Name:LANE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:LANE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-613-0430
Mailing Address - Street 1:3100 NW BUCKLIN HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8359
Mailing Address - Country:US
Mailing Address - Phone:360-613-0430
Mailing Address - Fax:360-308-0937
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8359
Practice Address - Country:US
Practice Address - Phone:360-613-0430
Practice Address - Fax:360-308-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002614261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000201453Medicare PIN