Provider Demographics
NPI:1194727339
Name:LANE, ROY LEON (DC)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:LEON
Last Name:LANE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67834-0218
Mailing Address - Country:US
Mailing Address - Phone:620-826-3539
Mailing Address - Fax:620-826-3539
Practice Address - Street 1:710 W CENTER ST
Practice Address - Street 2:
Practice Address - City:BUCKLIN
Practice Address - State:KS
Practice Address - Zip Code:67834-8831
Practice Address - Country:US
Practice Address - Phone:620-826-3539
Practice Address - Fax:620-826-3539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-3277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST71305Medicare UPIN
KS005443Medicare ID - Type UnspecifiedPROVIDER #