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General NPI Number Information
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NPI Number | 1487039665
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Entity Type | Organization
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Legal Business Name | MAYFIELD CHIROPRACTIC LAKE CHARLES
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 3101 LAKE ST STE 101
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8337
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Country | US
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Telephone | 337-656-4514
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Fax | 337-656-4517
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Provider Business Mailing Address
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Address Line | 3101 LAKE ST STE 101
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8337
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Country | US
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Telephone | 337-656-4514
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Fax | 337-656-4517
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | DR. SAMUEL MAYFIELD
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Credential | D.C.
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Telephone | 337-656-4514
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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 | 1607
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License Number State | LA
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