Provider Demographics
NPI:1902821986
Name:ARKANSAS LANE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:ARKANSAS LANE CHIROPRACTIC PA
Other - Org Name:DR MONTE ANDERSON
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-274-7776
Mailing Address - Street 1:3132 MATLOCK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2922
Mailing Address - Country:US
Mailing Address - Phone:817-274-7776
Mailing Address - Fax:817-274-0296
Practice Address - Street 1:3132 MATLOCK RD STE 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2922
Practice Address - Country:US
Practice Address - Phone:817-274-7776
Practice Address - Fax:817-274-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152222901Medicaid
TX609332Medicare ID - Type Unspecified
U78796Medicare UPIN