Healthcare Provider Details

I. General information

NPI: 1265982128
Provider Name (Legal Business Name): ASHLYN LANES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SCOTT AVE SUITE 2D
WOODLAND PARK CO
80863-1293
US

IV. Provider business mailing address

509 SCOTT AVE SUITE 2D
WOODLAND PARK CO
80863-1293
US

V. Phone/Fax

Practice location:
  • Phone: 719-687-6683
  • Fax: 719-686-9545
Mailing address:
  • Phone: 719-687-6683
  • Fax: 719-686-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0007470
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: