Organization Active NPI

Payne Chiropractic Center PA

  • Chiropractor
  • Statesville, NC
National Provider Identifier
1093765984
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1997 Issued in NC
Legal business name
PAYNE CHIROPRACTIC CENTER PA
Practice address
215 W Broad St
Statesville, NC 28677-5259
Phone
(704) 838-0990
Fax
(704) 838-0678
NPI assigned
May 11, 2006
Last updated
Dec 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey E Payne, DCNPI 1699726679
Title
Owner/President
Phone
(704) 838-0990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1997 NC Primary

Addresses

Primary practice location

215 W Broad St
Statesville, NC 28677-5259

Mailing address

215 W Broad St
Statesville, NC 28677-5259
Phone (704) 838-0990

Other identifiers 1

IdentifierTypeStateIssuer
890165LMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060120000723 NC Part B Supplier - Clinic/Group Practice 1951325679 Receives reassigned benefits from 1 practitioner
Practice locations: Statesville, NC

National Provider Directory

National Provider Directory

Locations

126 S Tradd St
Statesville, NC 28677
Phone (704) 838-0990

215 W Broad St
Statesville, NC 28677
Phone (704) 838-0990

215 W Broad St
Ste A
Statesville, NC 28677
Phone (704) 838-0990

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1093765984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775259",
            "telephone_number": "704-838-0990",
            "fax_number": "704-838-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W BROAD ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286775259",
            "telephone_number": "704-838-0990",
            "fax_number": "704-838-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAYNE CHIROPRACTIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "704-838-0990",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "1997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890165L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.