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321 Route 113, East Thetford, VT 05043 | |
(802) 565-0424 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Chiropractor |
Location | 321 Route 113, East Thetford, Vermont |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1386235307 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | (* (Not Available)) | Primary |
208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
Provider Name | Bonny Payne |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1740796523 PECOS PAC ID: 4385904085 Enrollment ID: I20210308000301 |
Mailing Address | Practice Location Address |
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Po Box 154, East Thetford, VT 05043-0154 Ph: (802) 565-0424 | 321 Route 113, East Thetford, VT 05043 Ph: (802) 565-0424 |