Provider Demographics
NPI:1205968302
Name:LANE, ERIC ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALLEN
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 1:550 W INA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4496
Mailing Address - Country:US
Mailing Address - Phone:520-742-7785
Mailing Address - Fax:520-797-3200
Practice Address - Street 1:550 W INA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4496
Practice Address - Country:US
Practice Address - Phone:520-742-7785
Practice Address - Fax:520-797-3200
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0241800OtherBLUE CROSS BLUE SHIELD
AZZ127541Medicare PIN
AZZDC5141Medicare ID - Type UnspecifiedMEDICARE