Healthcare Provider Details

I. General information

NPI: 1992944961
Provider Name (Legal Business Name): LANE CHIROPRACTIC & REHAB, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E. HIGHWAY 38
HARTFORD SD
57033
US

IV. Provider business mailing address

PO BOX 746
HARTFORD SD
57033-0746
US

V. Phone/Fax

Practice location:
  • Phone: 605-528-3135
  • Fax:
Mailing address:
  • Phone: 605-528-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1023
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1074
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1074
License Number StateSD

VIII. Authorized Official

Name: CHRISTOPHER W LANE
Title or Position: OWNER
Credential: D.C
Phone: 605-528-3135