Provider Demographics
NPI:1972293116
Name:LANE, QUANDACIA SHANTEL (DC)
Entity type:Individual
Prefix:MISS
First Name:QUANDACIA
Middle Name:SHANTEL
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 1:400 S ZANG BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6645
Mailing Address - Country:US
Mailing Address - Phone:469-317-7079
Mailing Address - Fax:
Practice Address - Street 1:400 S ZANG BLVD STE 1010
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6645
Practice Address - Country:US
Practice Address - Phone:469-317-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor