Provider Demographics
NPI:1982952800
Name:LANE, DAWNIELLE ROLLETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAWNIELLE
Middle Name:ROLLETTE
Last Name:LANE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 GRANBY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3436
Mailing Address - Country:US
Mailing Address - Phone:757-588-8908
Mailing Address - Fax:757-583-3069
Practice Address - Street 1:7400 GRANBY ST
Practice Address - Street 2:SUITE F
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3436
Practice Address - Country:US
Practice Address - Phone:757-588-8908
Practice Address - Fax:757-583-3069
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor