Provider Demographics
NPI:1588758254
Name:LANE, EMILY (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
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 1368
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-1368
Mailing Address - Country:US
Mailing Address - Phone:660-438-3330
Mailing Address - Fax:660-438-2222
Practice Address - Street 1:185 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355
Practice Address - Country:US
Practice Address - Phone:660-438-3330
Practice Address - Fax:660-438-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MON76D357Medicare ID - Type UnspecifiedV01640