| NPI | 1386904365 |
|---|---|
| Former Name | MIKE LANE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5987) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32295) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2019-05-20 |