Provider Demographics
NPI:1134258825
Name:PAYAN, ANTHONY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:PAYAN
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 1:648 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3347
Mailing Address - Country:US
Mailing Address - Phone:831-373-0188
Mailing Address - Fax:831-373-6979
Practice Address - Street 1:648 PINE AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3347
Practice Address - Country:US
Practice Address - Phone:831-373-0188
Practice Address - Fax:831-373-6979
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19245111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0192450OtherBLUE SHIELD
CA30016918OtherTAT
CAZZZ66746ZOtherBS GROUP #
CADC19254OtherBLUE CROSS
CAZZZ66746ZOtherBS GROUP #
CA30016918OtherTAT
CADC0192450OtherBLUE SHIELD