Jerry M Payne D.C., Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00003603 Issued in WA

Legal business name

JERRY M PAYNE D.C., INC

Practice address

1217 E 1St St
Port Angeles, WA 98362-4301

Phone

(360) 452-3017

Fax

(360) 452-4100

NPI assigned

Dec 18, 2007

Organization subpart

No

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

Authorized official

Name

Jerry M PayneNPI 1114913613

Title

Owner

Phone

(360) 452-3017

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerry M Payne, DC

  • Chiropractor
  • Port Angeles, WA
  • NPI 1114913613
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1396929006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 E 1ST ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624301",
            "telephone_number": "360-452-3017",
            "fax_number": "360-452-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 E 1ST ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624301",
            "telephone_number": "360-452-3017",
            "fax_number": "360-452-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY M PAYNE D.C., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-452-3017"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "G8851005",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "PA4216",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2022861",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR & INDUSTRIE",
            "identifier": "0124952",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcus Anthony Jeffries
• Consolacion Jellison, NAC
• Claire Jennings, ARNP, FNP-BC
• Michael Thomas Jennings, M.D.
• Brittney Jensen, LMHC, LPC
• David Jevne
• Juan M Jimenez
• Susana Jimenez, LMT
• William Joesel, HS
• John P Huard OD PLLC

• Chiropractor in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; 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.