Provider Demographics
NPI:1073840781
Name:MAYO CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:MAYO CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:KIP
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-625-6011
Mailing Address - Street 1:1551 N WALNUT AVE STE 40
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6047
Mailing Address - Country:US
Mailing Address - Phone:830-625-6011
Mailing Address - Fax:830-606-0398
Practice Address - Street 1:1551 N WALNUT AVE STE 40
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6047
Practice Address - Country:US
Practice Address - Phone:830-625-6011
Practice Address - Fax:830-606-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty