MEDICARE: DR. NICHOLAS RYAN PAYNE B.S., D.C.

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	2094	NE

General Provider Information

NPI Number	:	1366445009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS RYAN PAYNE B.S., D.C.

Provider Business Mailing Address
First Line	:	4815 N 163RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3241
Country	:	US
Telephone Number	:	859-653-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 N 163RD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3241
Country	:	US
Telephone Number	:	859-653-8307
Fax Number	:

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

Provider Enumeration Date	:	05/26/2005
Last Update Date	:	05/02/2023

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