Provider Demographics
NPI:1174822274
Name:ELY, PAYTON SPENCER (DC)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:SPENCER
Last Name:ELY
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 1:4586 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3033
Mailing Address - Country:US
Mailing Address - Phone:559-289-7877
Mailing Address - Fax:
Practice Address - Street 1:9340 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1224
Practice Address - Country:US
Practice Address - Phone:559-289-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor