Provider Demographics
NPI:1992875777
Name:PAYNE, TYAN ELIZABETH (DC)
Entity type:Individual
Prefix:MRS
First Name:TYAN
Middle Name:ELIZABETH
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7019
Mailing Address - Country:US
Mailing Address - Phone:907-376-2600
Mailing Address - Fax:907-376-2605
Practice Address - Street 1:546 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7019
Practice Address - Country:US
Practice Address - Phone:907-376-2600
Practice Address - Fax:907-376-2605
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0295Medicaid
00WFBYXBMedicare ID - Type Unspecified
U586560001Medicare UPIN