Provider Demographics
NPI:1881651198
Name:WRIGHT, LANE STANFORD (DC CCEP)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:STANFORD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DC CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8644
Mailing Address - Country:US
Mailing Address - Phone:208-375-3500
Mailing Address - Fax:208-375-3716
Practice Address - Street 1:1100 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8644
Practice Address - Country:US
Practice Address - Phone:208-375-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC5964OtherBC
350046101OtherRAILROAD MEDICARE
ID313314OtherBS
ID313314OtherBS