Individual
DR. JERRY M PAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1217 E 1ST ST, PORT ANGELES, WA 98362-4301
(360) 452-3017
(360) 452-4100
Mailing address
1217 E 1ST ST, PORT ANGELES, WA 98362-4301
(360) 452-3017
(360) 452-4100
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH00003603
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124952
L AND I
WA
05
—
2022861
—
WA
01
—
G8851006
MEDICARE GROUP PIN
WA
Enumeration date
09/21/2005
Last updated
12/28/2007
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