Provider Demographics
NPI:1932530243
Name:PAYNE, KELLEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLEIGH
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11750 BRICKSOME AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5332
Mailing Address - Country:US
Mailing Address - Phone:225-295-3494
Mailing Address - Fax:
Practice Address - Street 1:11750 BRICKSOME AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5332
Practice Address - Country:US
Practice Address - Phone:225-295-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1719111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation