Provider Demographics
NPI:1255366381
Name:MAYFIELD, JOHN L (DOCTOR OF CHIROPRACT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BRUNSWICK ROAD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-272-8839
Mailing Address - Fax:530-272-9057
Practice Address - Street 1:565 BRUNSWICK ROAD
Practice Address - Street 2:SUITE 12
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-8839
Practice Address - Fax:530-272-9057
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor