Provider Demographics
NPI:1689077141
Name:BAYNE, FIONA INDIRA (DC)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:INDIRA
Last Name:BAYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FM 1765
Mailing Address - Street 2:SUITE C
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590
Mailing Address - Country:US
Mailing Address - Phone:409-948-3094
Mailing Address - Fax:409-948-8574
Practice Address - Street 1:3300 FM 1765
Practice Address - Street 2:SUITE C
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590
Practice Address - Country:US
Practice Address - Phone:409-948-3094
Practice Address - Fax:409-948-8574
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12829111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor