Provider Demographics
NPI:1548770324
Name:PAYNE, DYLAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:J
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 1:805 DULWICH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6515
Mailing Address - Country:US
Mailing Address - Phone:512-589-8967
Mailing Address - Fax:
Practice Address - Street 1:1106 COLLEGE ST STE A
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3948
Practice Address - Country:US
Practice Address - Phone:512-441-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX615934ZHUEOtherMEDICARE