MEDICARE: DR. ERIC MAYFIELD 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	4307	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598838567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC MAYFIELD D.C.

Provider Business Mailing Address
First Line	:	1221 W LAKE ST
Second Line	:	102
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3397
Country	:	US
Telephone Number	:	612-874-0705
Fax Number	:	612-874-0713

Provider Business Practice Location Address
First Line	:	1221 W LAKE ST
Second Line	:	102
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3397
Country	:	US
Telephone Number	:	612-874-0705
Fax Number	:	612-874-0713

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/03/2010

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