Provider Demographics
NPI:1003304684
Name:LANE, LAURA (DC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BURSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6462 LOSEE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-0104
Mailing Address - Country:US
Mailing Address - Phone:702-608-3362
Mailing Address - Fax:
Practice Address - Street 1:6462 LOSEE RD STE 125
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-0104
Practice Address - Country:US
Practice Address - Phone:702-306-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-29
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6504111N00000X
NVB01709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor