Provider Demographics
NPI:1134549025
Name:LANE, KRISTOPHER MARTIN (DC)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MARTIN
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 1:7631 212TH ST SW
Mailing Address - Street 2:105B
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7565
Mailing Address - Country:US
Mailing Address - Phone:903-742-1072
Mailing Address - Fax:425-775-9608
Practice Address - Street 1:7631 212TH ST SW
Practice Address - Street 2:105B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7565
Practice Address - Country:US
Practice Address - Phone:903-742-1072
Practice Address - Fax:425-775-9608
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60443467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0325925OtherLABOR AND INDUSTRIES
WA0325925OtherLABOR AND INDUSTRIES