Provider Demographics
NPI:1942295126
Name:LANE, ROGER S (DC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:S
Last Name:LANE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4467
Mailing Address - Country:US
Mailing Address - Phone:860-346-8000
Mailing Address - Fax:860-347-4215
Practice Address - Street 1:282 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4467
Practice Address - Country:US
Practice Address - Phone:860-346-8000
Practice Address - Fax:860-347-4215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor