Provider Demographics
NPI:1083719116
Name:CENTER FOR WELL BEING, P.C.
Entity Type:Organization
Organization Name:CENTER FOR WELL BEING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-885-0822
Mailing Address - Street 1:7901 XERXES AVE S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1253
Mailing Address - Country:US
Mailing Address - Phone:952-885-0822
Mailing Address - Fax:952-885-9180
Practice Address - Street 1:7901 XERXES AVE S
Practice Address - Street 2:SUITE 300
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1253
Practice Address - Country:US
Practice Address - Phone:952-885-0822
Practice Address - Fax:952-885-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1758111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04S89MIOtherBLUE CROSS BLUE SHIELD