Provider Demographics
NPI:1699726679
Name:PAYNE, JEFFREY E (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
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 1:215 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5259
Mailing Address - Country:US
Mailing Address - Phone:704-838-0990
Mailing Address - Fax:704-838-0678
Practice Address - Street 1:126 S TRADD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5863
Practice Address - Country:US
Practice Address - Phone:704-838-0990
Practice Address - Fax:704-838-0678
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6908707Medicaid
NC2448031CMedicare ID - Type Unspecified
NCU43611Medicare UPIN