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General NPI Number Information
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NPI Number | 1356438295
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Entity Type | Organization
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Legal Business Name | MAYFIELD CHIROPRACTIC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 2168 HWY 361
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City | INGLESIDE
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State | TX
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Zip | 78362
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Country | US
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Telephone | 361-776-0030
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Fax | 361-776-0731
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Provider Business Mailing Address
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Address Line | 2168 HWY 361
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City | INGLESIDE
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State | TX
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Zip | 78362
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Country | US
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Telephone | 361-776-0030
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Fax | 361-776-0731
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DWAYNE ALLEN KUBECKA
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Credential | D.C.
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Telephone | 361-776-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC6561
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License Number State | TX
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