Provider Demographics
NPI:1568539641
Name:MAYFIELD, CHARLES WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:MAYFIELD
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: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:318-396-5558
Mailing Address - Fax:318-396-9119
Practice Address - Street 1:4900 CYPRESS ST
Practice Address - Street 2:SUITE 13
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7670
Practice Address - Country:US
Practice Address - Phone:318-396-5558
Practice Address - Fax:318-396-9119
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H263CN28Medicare ID - Type UnspecifiedMEDICARE GROUP
LAV03213Medicare UPIN
LA4H263Medicare ID - Type UnspecifiedPROVIDER