Provider Demographics
NPI:1619291697
Name:PAYNE, ATHENA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:MARIE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4233
Mailing Address - Country:US
Mailing Address - Phone:817-731-4848
Mailing Address - Fax:817-731-4858
Practice Address - Street 1:4255 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4233
Practice Address - Country:US
Practice Address - Phone:817-731-4848
Practice Address - Fax:817-731-4858
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437483831OtherMEDICARE GROUP NPI SALANCE CLINIC INC.
TXTXB127631OtherMEDICARE PTAN GROUP