Provider Demographics
NPI:1669572194
Name:LANING, MARK J (DC, OPA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LANING
Suffix:
Gender:M
Credentials:DC, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 SAM RAYBURN RUN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3215
Mailing Address - Country:US
Mailing Address - Phone:972-951-3241
Mailing Address - Fax:
Practice Address - Street 1:5710 LBJ FWY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6324
Practice Address - Country:US
Practice Address - Phone:972-951-3241
Practice Address - Fax:888-238-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6563OtherCHIROPRACTIC LICENSE