MEDICARE: DR. DYLAN J PAYNE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	13621	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	615934ZHUE	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1548770324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DYLAN J PAYNE DC

Provider Business Mailing Address
First Line	:	805 DULWICH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6515
Country	:	US
Telephone Number	:	512-589-8967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 COLLEGE ST STE A
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3948
Country	:	US
Telephone Number	:	512-441-1240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2017
Last Update Date	:	11/29/2017

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