Provider Demographics
NPI:1093765984
Name:PAYNE CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:PAYNE CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-838-0990
Mailing Address - Street 1:215 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5259
Mailing Address - Country:US
Mailing Address - Phone:704-838-0990
Mailing Address - Fax:704-838-0678
Practice Address - Street 1:215 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5259
Practice Address - Country:US
Practice Address - Phone:704-838-0990
Practice Address - Fax:704-838-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890165LMedicaid
NC2453606Medicare ID - Type Unspecified
NC890165LMedicaid