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General NPI Number Information
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NPI Number | 1356681290
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Entity Type | Organization
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Legal Business Name | DALE MANSFIELD CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 4107 W ILLINOIS AVE
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City | MIDLAND
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State | TX
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Zip | 79703-5526
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Country | US
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Telephone | 432-697-1643
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Fax | 432-694-7939
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Provider Business Mailing Address
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Address Line | 4107 W ILLINOIS AVE
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City | MIDLAND
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State | TX
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Zip | 79703-5526
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Country | US
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Telephone | 432-697-1643
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Fax | 432-694-7939
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DALE LYNN MANSFIELD
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Credential | D.C.
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Telephone | 432-697-1643
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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 | F00237378
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License Number State | TX
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