Provider Demographics
NPI:1083734842
Name:MANSFIELD LOFTIS, TONJA L (DC)
Entity Type:Individual
Prefix:DR
First Name:TONJA
Middle Name:L
Last Name:MANSFIELD LOFTIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TONJA
Other - Middle Name:L
Other - Last Name:MANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4505 ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2219
Mailing Address - Country:US
Mailing Address - Phone:432-697-1643
Mailing Address - Fax:432-694-7939
Practice Address - Street 1:4107 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5526
Practice Address - Country:US
Practice Address - Phone:432-697-1643
Practice Address - Fax:432-694-7939
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340336YY0BMedicare PIN