Provider Demographics
NPI:1316376734
Name:MANSFIELD CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MANSFIELD CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-924-3302
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-0045
Mailing Address - Country:US
Mailing Address - Phone:417-924-3302
Mailing Address - Fax:417-924-8684
Practice Address - Street 1:101B N BUSINESS 60
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704-7101
Practice Address - Country:US
Practice Address - Phone:417-924-3302
Practice Address - Fax:417-924-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003674261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center