Provider Demographics
NPI:1942547518
Name:CHIROPRACTIC LANE AND REHAB, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC LANE AND REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-344-5656
Mailing Address - Street 1:290 FERRY ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3475
Mailing Address - Country:US
Mailing Address - Phone:973-344-5656
Mailing Address - Fax:973-344-5633
Practice Address - Street 1:290 FERRY ST
Practice Address - Street 2:SUITE A1
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3475
Practice Address - Country:US
Practice Address - Phone:973-344-5656
Practice Address - Fax:973-344-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00671700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty