Provider Demographics
NPI:1356349567
Name:PAYTON, ROGER ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALAN
Last Name:PAYTON
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 1:2481 ATHENS AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2838
Mailing Address - Country:US
Mailing Address - Phone:530-223-5003
Mailing Address - Fax:
Practice Address - Street 1:2481 ATHENS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2838
Practice Address - Country:US
Practice Address - Phone:530-223-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0122450Medicare ID - Type Unspecified
CAT04690Medicare UPIN