Provider Demographics
NPI:1942505599
Name:MAYFIELD CHIROPRACTIC WELLNESS CENTER,PLLC
Entity Type:Organization
Organization Name:MAYFIELD CHIROPRACTIC WELLNESS CENTER,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESJARLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-247-2121
Mailing Address - Street 1:118 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2214
Mailing Address - Country:US
Mailing Address - Phone:270-247-2121
Mailing Address - Fax:
Practice Address - Street 1:118 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2314
Practice Address - Country:US
Practice Address - Phone:270-247-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty