Provider Demographics
NPI:1134355076
Name:LANE, WILLIAM RUSSELL (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUSSELL
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-0460
Mailing Address - Country:US
Mailing Address - Phone:405-547-2473
Mailing Address - Fax:405-547-2925
Practice Address - Street 1:509 E HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-4129
Practice Address - Country:US
Practice Address - Phone:405-547-2473
Practice Address - Fax:405-547-2925
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor