Provider Demographics
NPI:1366583379
Name:LANE, GREGORY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
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 1:960 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1830
Mailing Address - Country:US
Mailing Address - Phone:970-874-9724
Mailing Address - Fax:970-874-9724
Practice Address - Street 1:960 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1830
Practice Address - Country:US
Practice Address - Phone:970-874-9724
Practice Address - Fax:970-874-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor