Provider Demographics
NPI:1427213693
Name:PAYNE, JEREMY LAMONT (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:LAMONT
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 1:951 E PLAZA DR STE 170
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6569
Mailing Address - Country:US
Mailing Address - Phone:208-917-2928
Mailing Address - Fax:
Practice Address - Street 1:951 E PLAZA DR STE 170
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6569
Practice Address - Country:US
Practice Address - Phone:208-917-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1861365175F00000X
IDCHIA-1965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259360AMedicare PIN