1023294758 NPI number — PAYTON CHIROPRACTIC CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023294758 NPI number — PAYTON CHIROPRACTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAYTON CHIROPRACTIC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023294758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 715
Provider Second Line Business Mailing Address:
PAYTON CHIROPRACTIC CENTER, INC.
Provider Business Mailing Address City Name:
WELLS RIVER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05081-0715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-757-2414
Provider Business Mailing Address Fax Number:
802-757-2415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 MAIN ST
Provider Second Line Business Practice Location Address:
PAYTON CHIROPRACTIC CENTER, INC.
Provider Business Practice Location Address City Name:
WELLS RIVER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05081-9700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-757-2414
Provider Business Practice Location Address Fax Number:
802-757-2415
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAYTON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-757-2414

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0060001129 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023294758 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1467424747 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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