Provider Demographics
NPI:1760620421
Name:PAYNE, GARY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
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 1:4142 MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1609
Mailing Address - Country:US
Mailing Address - Phone:816-931-3506
Mailing Address - Fax:
Practice Address - Street 1:4301 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-7701
Practice Address - Country:US
Practice Address - Phone:816-877-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008035499111N00000X
KS01-05236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor