Healthcare Provider Details

I. General information

NPI: 1194727339
Provider Name (Legal Business Name): ROY LEON LANE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W CENTER ST
BUCKLIN KS
67834-8831
US

IV. Provider business mailing address

PO BOX 218
BUCKLIN KS
67834-0218
US

V. Phone/Fax

Practice location:
  • Phone: 620-826-3539
  • Fax: 620-826-3539
Mailing address:
  • Phone: 620-826-3539
  • Fax: 620-826-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberC-3277
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: