Healthcare Provider Details

I. General information

NPI: 1780834937
Provider Name (Legal Business Name): LANE CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NW BUCKLIN HILL RD STE 101
SILVERDALE WA
98383-8359
US

IV. Provider business mailing address

3100 NW BUCKLIN HILL RD STE 101
SILVERDALE WA
98383-8359
US

V. Phone/Fax

Practice location:
  • Phone: 360-613-0430
  • Fax: 360-308-0937
Mailing address:
  • Phone: 360-613-0430
  • Fax: 360-308-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCH00002614
License Number StateWA

VIII. Authorized Official

Name: DR. TONY LANE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 360-613-0430