MEDICARE: DR. SAMUEL RAY 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	1607	LA

General Provider Information

NPI Number	:	1912298472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL RAY MAYFIELD D.C.

Provider Business Mailing Address
First Line	:	PO BOX 12144
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71315-2144
Country	:	US
Telephone Number	:	318-787-2708
Fax Number	:	318-787-2716

Provider Business Practice Location Address
First Line	:	5419 JACKSON STREET EXT
Second Line	:	SUITE B
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2322
Country	:	US
Telephone Number	:	318-787-2708
Fax Number	:	318-787-2716

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

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	06/03/2011

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