Provider Demographics
NPI:1336132463
Name:PAYNE, HAROLD LOUIS (DC)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:LOUIS
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 1:202 S RODNEY PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4710
Mailing Address - Country:US
Mailing Address - Phone:501-224-5610
Mailing Address - Fax:501-224-2939
Practice Address - Street 1:202 S RODNEY PARHAM RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4710
Practice Address - Country:US
Practice Address - Phone:501-224-5610
Practice Address - Fax:501-224-2939
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-05-26
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
AR860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59724Medicare PIN
ART20688Medicare UPIN