Provider Demographics
NPI:1184848756
Name:MAYFIELD CHIROPRACTIC JONESBORO, LLC
Entity Type:Organization
Organization Name:MAYFIELD CHIROPRACTIC JONESBORO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-396-5558
Mailing Address - Street 1:PO BOX 2274
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2274
Mailing Address - Country:US
Mailing Address - Phone:318-395-2565
Mailing Address - Fax:318-395-2567
Practice Address - Street 1:520 S. POLK ST.
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251
Practice Address - Country:US
Practice Address - Phone:318-395-2565
Practice Address - Fax:318-395-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty