Provider Demographics
NPI:1740796523
Name:PAYNE, BONNY (DC)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:
Last Name:PAYNE
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POST MILLS
Mailing Address - State:VT
Mailing Address - Zip Code:05058-0068
Mailing Address - Country:US
Mailing Address - Phone:802-565-0424
Mailing Address - Fax:
Practice Address - Street 1:1461 BLOOD BROOK RD
Practice Address - Street 2:
Practice Address - City:FAIRLEE
Practice Address - State:VT
Practice Address - Zip Code:05045-9847
Practice Address - Country:US
Practice Address - Phone:321-750-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-16
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12315111N00000X
VT006.0134153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty