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General NPI Number Information
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NPI Number | 1932403086
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Entity Type | Organization
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Legal Business Name | LANE CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 401 PARK DR
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City | MARENGO
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State | IL
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Zip | 60152-2903
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Country | US
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Telephone | 815-568-8411
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Fax | 815-568-6252
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Provider Business Mailing Address
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Address Line | 401 PARK DR
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City | MARENGO
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State | IL
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Zip | 60152-2903
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Country | US
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Telephone | 815-568-8411
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Fax | 815-568-6252
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE R LANE
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Credential | D.C.
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Telephone | 815-568-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-007697
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License Number State | IL
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