1588965875 NPI number — LANE CHIROPRACTIC AND WELLNESS, PLLC

Table of content: MICHAEL JOSEPH GONZALEZ SOTO (NPI 1750869376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588965875 NPI number — LANE CHIROPRACTIC AND WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LANE CHIROPRACTIC AND WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588965875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 ASPEN GROVE DR
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-4873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-807-1475
Provider Business Mailing Address Fax Number:
615-810-8989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 ASPEN GROVE DR
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-4873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-807-1475
Provider Business Practice Location Address Fax Number:
615-810-8989
Provider Enumeration Date:
11/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LANE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-807-1475

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2226 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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