1134185226 NPI number — DR. JOHN P LANE D.C., F.I.A.M.A

Table of content: DR. JOHN P LANE D.C., F.I.A.M.A (NPI 1134185226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134185226 NPI number — DR. JOHN P LANE D.C., F.I.A.M.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., F.I.A.M.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1134185226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4233 E DES MOINES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-6224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-985-3827
Provider Business Mailing Address Fax Number:
408-396-9467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 E FALCON DR
Provider Second Line Business Practice Location Address:
#116-117
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85215-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-969-8848
Provider Business Practice Location Address Fax Number:
480-396-9467
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5372 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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