Provider Demographics
NPI:1134185226
Name:LANE, JOHN P (DC, FIAMA)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:LANE
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 E DES MOINES ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6224
Mailing Address - Country:US
Mailing Address - Phone:480-985-3827
Mailing Address - Fax:408-396-9467
Practice Address - Street 1:4710 E FALCON DR
Practice Address - Street 2:#116-117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2500
Practice Address - Country:US
Practice Address - Phone:480-969-8848
Practice Address - Fax:480-396-9467
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ68142Medicare ID - Type Unspecified
AZU55364Medicare UPIN