Provider Demographics
NPI:1558411793
Name:MAYLAND, ASHLEY BROOKS (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOKS
Last Name:MAYLAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-2004
Mailing Address - Country:US
Mailing Address - Phone:605-767-7463
Mailing Address - Fax:605-767-7464
Practice Address - Street 1:303 W WILLOW STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2004
Practice Address - Country:US
Practice Address - Phone:605-767-7463
Practice Address - Fax:605-767-7464
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD699380OtherACN GROUP PROVIDER NUMBER
SDC1076OtherDAKOTACARE
SD250332OtherMIDLANDS CHOICE
SD7604410Medicaid
SD15174OtherAVERA HEALTH PLANS
SD49966OtherSIOUX VALLEY HEALTH PLAN
SD4994167OtherWELLMARK
SD699380OtherACN GROUP PROVIDER NUMBER
SD4994167OtherWELLMARK