Provider Demographics
NPI:1194947234
Name:LANE CHIROPRACTICE CLINIC, PC
Entity type:Organization
Organization Name:LANE CHIROPRACTICE CLINIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LABORET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-671-5263
Mailing Address - Street 1:13520 T I BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1563
Mailing Address - Country:US
Mailing Address - Phone:972-671-1158
Mailing Address - Fax:
Practice Address - Street 1:13520 T I BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1563
Practice Address - Country:US
Practice Address - Phone:972-671-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z650Medicare PIN
TXU63985Medicare UPIN