Provider Demographics
NPI:1366445009
Name:PAYNE, NICHOLAS RYAN (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RYAN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 N 163RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3241
Mailing Address - Country:US
Mailing Address - Phone:859-653-8307
Mailing Address - Fax:
Practice Address - Street 1:4815 N 163RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-3241
Practice Address - Country:US
Practice Address - Phone:859-653-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY407350156OtherRAILROAD MEDICARE
KYK4823COtherHUMANA
KY000000317520OtherBLUE CROSS
KY407350156OtherRAILROAD MEDICARE