Provider Demographics
NPI:1760127740
Name:MAYFIELD, KYLE ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
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 1:2405 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3019
Mailing Address - Country:US
Mailing Address - Phone:318-828-1517
Mailing Address - Fax:318-828-1685
Practice Address - Street 1:2405 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3019
Practice Address - Country:US
Practice Address - Phone:318-828-1517
Practice Address - Fax:318-828-1685
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor