Provider Demographics
NPI:1023066073
Name:LANE, JOSEPH TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TIMOTHY
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 1:31 APOSTLE CT.
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2776
Mailing Address - Country:US
Mailing Address - Phone:636-225-0489
Mailing Address - Fax:
Practice Address - Street 1:604 E. LOCKWOOD
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-3219
Practice Address - Country:US
Practice Address - Phone:314-968-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004876111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO44-01192OtherUNITED HEALTH CARE
MO9360OtherBLUE CROSS BLUE SHEID
MO114153OtherHEALTH LINK
MO625709OtherACN
MO2027274OtherAETNA
MO000030135Medicare ID - Type Unspecified
MO114153OtherHEALTH LINK