Provider Demographics
NPI:1366555302
Name:LANE, DANIEL GJ (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GJ
Last Name:LANE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 NINA LN
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1901
Mailing Address - Country:US
Mailing Address - Phone:410-829-9201
Mailing Address - Fax:410-219-3579
Practice Address - Street 1:1324 BELMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4543
Practice Address - Country:US
Practice Address - Phone:410-219-5155
Practice Address - Fax:410-219-3579
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor