Organization
JERRY M PAYNE D.C., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY M PAYNE (OWNER)
(360) 452-3017
Entity
Organization
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
—
0124952
DEPT OF LABOR & INDUSTRIE
WA
05
—
2022861
—
WA
01
—
G8851005
MEDICARE GROUP PIN
WA
01
—
PA4216
REGENCE BLUE SHIELD
WA
Enumeration date
12/18/2007
Last updated
10/17/2012
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