Provider Demographics
NPI:1841371275
Name:PAYNE, GAVIN TODD (DC)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:TODD
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 1:303 OCONNELL ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2637
Mailing Address - Country:US
Mailing Address - Phone:507-532-7458
Mailing Address - Fax:507-532-5612
Practice Address - Street 1:705 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3311
Practice Address - Country:US
Practice Address - Phone:308-384-4955
Practice Address - Fax:308-384-7088
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN246P3PAOtherBCBS
MN929453800Medicaid
MN48654OtherSIOUX VALLEY HEALTH PLAN
MN48654OtherSIOUX VALLEY HEALTH PLAN
MN350003481Medicare ID - Type UnspecifiedMEDICDARE