Healthcare Provider Details

I. General information

NPI: 1639591431
Provider Name (Legal Business Name): MAYFIELD WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 LONG PRAIRIE RD SUITE 105
FLOWER MOUND TX
75022-4839
US

IV. Provider business mailing address

2915 WINDRIDGE LN
CORINTH TX
76208-4842
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-8002
  • Fax: 972-899-8003
Mailing address:
  • Phone: 972-899-8002
  • Fax: 972-899-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12248
License Number StateTX

VIII. Authorized Official

Name: DIXIE MAYFIELD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 972-746-3522