Provider Demographics
NPI:1942496831
Name:PAYNE, DOUGLAS GLENN (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GLENN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 FRANKLIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1280
Mailing Address - Country:US
Mailing Address - Phone:540-556-0069
Mailing Address - Fax:
Practice Address - Street 1:1035 FRANKLIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1280
Practice Address - Country:US
Practice Address - Phone:540-556-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor