Provider Demographics
NPI:1356681290
Name:DALE MANSFIELD CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:DALE MANSFIELD CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-697-1643
Mailing Address - Street 1:4107 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5526
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF00237378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty