MEDICARE: DR. ATHENA MARIE PAYNE 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	11597	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437483831	OTHER	TX	MEDICARE GROUP NPI SALANCE CLINIC INC.
2	TXB127631	OTHER	TX	MEDICARE PTAN GROUP

General Provider Information

NPI Number	:	1619291697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATHENA MARIE PAYNE D.C.

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	SUITE 108
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-731-4848
Fax Number	:	817-731-4858

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD
Second Line	:	SUITE 108
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4233
Country	:	US
Telephone Number	:	817-731-4848
Fax Number	:	817-731-4858

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

Provider Enumeration Date	:	03/20/2010
Last Update Date	:	04/15/2016

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Directions to “ DR. ATHENA MARIE PAYNE D.C.” Practice Location

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