Provider Demographics
NPI:1316085707
Name:PAYNE, THOMAS J (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
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 1:1855 E VISTA WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3315
Mailing Address - Country:US
Mailing Address - Phone:760-940-2028
Mailing Address - Fax:760-940-2077
Practice Address - Street 1:1855 E VISTA WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3315
Practice Address - Country:US
Practice Address - Phone:760-940-2028
Practice Address - Fax:760-940-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18909OtherCA. DC LICENCE