Provider Demographics
NPI:1386061893
Name:MILTON L. PAYNE INCORPORATED
Entity type:Organization
Organization Name:MILTON L. PAYNE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-774-3535
Mailing Address - Street 1:19231 VICTORY BLVD.
Mailing Address - Street 2:557
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6379
Mailing Address - Country:US
Mailing Address - Phone:818-774-3535
Mailing Address - Fax:818-774-3533
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 557
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-774-3535
Practice Address - Fax:818-774-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881713162Medicare PIN