MEDICARE: DR. KATRINA S MAYES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104556826	VA

General Provider Information

NPI Number	:	1437463973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA S MAYES D.C.

Provider Business Mailing Address
First Line	:	16021 KAIROS RD
Second Line	:	SUITE C
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-536-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	16021 KAIROS RD
Second Line	:	SUITE C
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5205
Country	:	US
Telephone Number	:	804-536-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	10/12/2016

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