Provider Demographics
NPI:1316011067
Name:PAYNE, LARRY C (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
Last Name:PAYNE
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 1:670 RIVER OAKS PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1988
Mailing Address - Country:US
Mailing Address - Phone:408-435-1133
Mailing Address - Fax:408-435-1166
Practice Address - Street 1:670 RIVER OAKS PKWY STE K
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1988
Practice Address - Country:US
Practice Address - Phone:408-435-1133
Practice Address - Fax:408-435-1166
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12466Medicare ID - Type Unspecified