=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083734842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONJA L MANSFIELD LOFTIS DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 10/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4107 W ILLINOIS AVE
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79703-5526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-697-1643
-----------------------------------------------------
Fax | 432-694-7939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4505 ROBIN LN
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79707-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-697-1643
-----------------------------------------------------
Fax | 432-694-7939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9463
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------