Provider Demographics
NPI:1396704151
Name:PAYTON, LAWRENCE H (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
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 1:4303 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1514
Mailing Address - Country:US
Mailing Address - Phone:317-781-9636
Mailing Address - Fax:317-781-9635
Practice Address - Street 1:4303 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1514
Practice Address - Country:US
Practice Address - Phone:317-781-9636
Practice Address - Fax:317-781-9635
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001826A111N00000X
IN81000010A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000277442OtherANTHEM
IN200216490BMedicaid
IN201600AMedicare PIN
INU94392Medicare UPIN