Provider Demographics
NPI:1942304340
Name:MANSFIELD, WALTER KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:KENNETH
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 1:4614 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4735
Mailing Address - Country:US
Mailing Address - Phone:325-695-5220
Mailing Address - Fax:325-695-5222
Practice Address - Street 1:4614 S 14TH
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4735
Practice Address - Country:US
Practice Address - Phone:325-695-5220
Practice Address - Fax:325-695-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000869001Medicaid
TX600134OtherBCBS
TX752202185OtherCOMMERCIAL
TX752202185OtherCOMMERCIAL
TX600134Medicare ID - Type Unspecified