Organization
EVOLUTION JOINT PAIN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY PAYNE DC (OWNER)
(503) 756-5317
Entity
Organization
Contact information
Practice address
947 E WINDING CREEK DR STE 200, EAGLE, ID 83616-7231
(208) 917-2928
Mailing address
947 E WINDING CREEK DR STE 200, EAGLE, ID 83616-7231
(208) 917-2928
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
09/29/2021
Last updated
10/21/2021
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