MEDICARE: DR. DAVID R LANE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	156159-1202	UT

General Provider Information

NPI Number	:	1225138100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R LANE D.C.

Provider Business Mailing Address
First Line	:	75 E 600 S
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3227
Country	:	US
Telephone Number	:	435-734-2095
Fax Number	:	435-734-0731

Provider Business Practice Location Address
First Line	:	75 E 600 S
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3227
Country	:	US
Telephone Number	:	435-734-2095
Fax Number	:	435-734-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/17/2007

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