Provider Demographics
NPI:1912298472
Name:MAYFIELD, SAMUEL RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAY
Last Name:MAYFIELD
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:PO BOX 12144
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2144
Mailing Address - Country:US
Mailing Address - Phone:318-787-2708
Mailing Address - Fax:318-787-2716
Practice Address - Street 1:5419 JACKSON STREET EXT
Practice Address - Street 2:SUITE B
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2322
Practice Address - Country:US
Practice Address - Phone:318-787-2708
Practice Address - Fax:318-787-2716
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor