Doctor Name: | KENNETH G LANE |
NPI Number: | 1942482716 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | CE003008 |
Business Practice Address: | 1402 Nw 10th Lane Ava, MO - 656080563 |
Business Phone Number: | 4176833333 |
Business Fax Number: | 4176834626 |
Mailing Address: | Po Box 563, AVA |
State: | MO |
Postal Code: | 65608 |
Phone Number: | 4176833333 |
Fax Number: | 4176834626 |
NPI Enumeration Date: | 12/03/2007 |
NPI Last Update Date: | 12/03/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | CE003008 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |