Provider Demographics
NPI:1609973502
Name:MANSFIELD, DALE L (DC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:MANSFIELD
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 1:4107 W ILLINOIS
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
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703
Practice Address - Country:US
Practice Address - Phone:432-697-1643
Practice Address - Fax:432-694-7939
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000929201Medicaid
T14583Medicare UPIN
TX000929201Medicaid