Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 6504 | MN |
Y | 111N00000X | Chiropractor | B01709 | NV |
NPI | 1003304684 |
---|---|
Provider Name | Laura Lane |
First Address | North Las Vegas, NV 89086-0104 |
Second Address | North Las Vegas, NV 89086-0104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2018 |
Last Update Date | 02/04/2020 |