Provider Demographics
NPI:1487039665
Name:MAYFIELD CHIROPRACTIC LAKE CHARLES
Entity type:Organization
Organization Name:MAYFIELD CHIROPRACTIC LAKE CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-656-4514
Mailing Address - Street 1:3101 LAKE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8337
Mailing Address - Country:US
Mailing Address - Phone:337-656-4514
Mailing Address - Fax:337-656-4517
Practice Address - Street 1:3101 LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8337
Practice Address - Country:US
Practice Address - Phone:337-656-4514
Practice Address - Fax:337-656-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty