Provider Demographics
NPI:1811020092
Name:PAYSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PAYSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-465-4888
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-0448
Mailing Address - Country:US
Mailing Address - Phone:801-465-4888
Mailing Address - Fax:801-465-4892
Practice Address - Street 1:55 S 100 E
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2201
Practice Address - Country:US
Practice Address - Phone:801-465-4888
Practice Address - Fax:801-465-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1659181202111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5687Medicare ID - Type Unspecified