Provider Demographics
NPI:1649564956
Name:MAYFIELD CHIROPRACTIC ALEXANDRIA L.L.C.
Entity Type:Organization
Organization Name:MAYFIELD CHIROPRACTIC ALEXANDRIA L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-787-2708
Mailing Address - Street 1:PO BOX 12144
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2144
Mailing Address - Country:US
Mailing Address - Phone:318-787-2708
Mailing Address - Fax:318-787-2716
Practice Address - Street 1:5419 JACKSON STREET EXT
Practice Address - Street 2:SUITE B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2322
Practice Address - Country:US
Practice Address - Phone:318-787-2708
Practice Address - Fax:318-787-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty