=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699726679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY E PAYNE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 S TRADD ST
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-5863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-838-0990
-----------------------------------------------------
Fax | 704-838-0678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 W BROAD ST
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-5259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-838-0990
-----------------------------------------------------
Fax | 704-838-0678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1997
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------