Provider Demographics
NPI:1457436560
Name:MAYFIELD, LYNETTE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:RENEE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RICHARDSON XING
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6006
Mailing Address - Country:US
Mailing Address - Phone:636-464-8360
Mailing Address - Fax:636-464-2180
Practice Address - Street 1:101 RICHARDSON XING
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6006
Practice Address - Country:US
Practice Address - Phone:636-464-8360
Practice Address - Fax:636-464-2180
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001008726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152032OtherBCBS
MO519928OtherHEALTHLINK
MO000031944Medicare PIN
MO519928OtherHEALTHLINK