Provider Demographics
NPI:1215197298
Name:DALE MANSFIELD D.C.
Entity Type:Organization
Organization Name:DALE MANSFIELD D.C.
Other - Org Name:MANSFIELD CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANDFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-697-1643
Mailing Address - Street 1:4107 W ILLIONOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703
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:432-694-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000929201Medicaid
TX000929201Medicaid