Provider Demographics
NPI:1023294758
Name:PAYTON CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:PAYTON CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-757-2414
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:PAYTON CHIROPRACTIC CENTER, INC.
Mailing Address - City:WELLS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05081-0715
Mailing Address - Country:US
Mailing Address - Phone:802-757-2414
Mailing Address - Fax:802-757-2415
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:PAYTON CHIROPRACTIC CENTER, INC.
Practice Address - City:WELLS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05081-9700
Practice Address - Country:US
Practice Address - Phone:802-757-2414
Practice Address - Fax:802-757-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023294758OtherGROUP NPI
1467424747OtherINDIVIDUAL NPI
VN3931Medicare PIN
1023294758OtherGROUP NPI