| Doctor Name: | DR. CRAIG LANE MARCOM |
| NPI Number: | 1669704839 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | DC16715 |
| Business Practice Address: | 3211 Lawnview Ave Loomis, CA - 956508759 |
| Business Phone Number: | 9162131761 |
| Business Fax Number: | 9166524497 |
| Mailing Address: | 3211 Lawnview Ave, LOOMIS |
| State: | CA |
| Postal Code: | 956508759 |
| Phone Number: | 9162131761 |
| Fax Number: | 9166524497 |
| NPI Enumeration Date: | 02/12/2010 |
| NPI Last Update Date: | 02/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111NI0013X |
| License Number: | DC16715 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | Independent Medical Examiner |
| Taxonomy Definition: | A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues. |