=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528118270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L.B. PAYNE D.C. P.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7349 BURLINGTON PIKE
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41042-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-525-7443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7349 BURLINGTON PIKE
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41042-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-525-7443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NICHOLAS R PAYNE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 859-525-7443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4823
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------