Provider Demographics
NPI:1669632097
Name:MAYFIELD CHIROPRACTIC WELLNESS CENTRE, SC
Entity type:Organization
Organization Name:MAYFIELD CHIROPRACTIC WELLNESS CENTRE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-833-7471
Mailing Address - Street 1:427 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1040
Mailing Address - Country:US
Mailing Address - Phone:608-833-7471
Mailing Address - Fax:608-833-3286
Practice Address - Street 1:427 GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1040
Practice Address - Country:US
Practice Address - Phone:608-833-7471
Practice Address - Fax:608-833-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1941261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075951Medicare UPIN
WI000075951Medicare PIN