Provider Demographics
NPI:1598838567
Name:MAYFIELD, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:1221 W LAKE ST
Mailing Address - Street 2:102
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3397
Mailing Address - Country:US
Mailing Address - Phone:612-874-0705
Mailing Address - Fax:612-874-0713
Practice Address - Street 1:1221 W LAKE ST
Practice Address - Street 2:102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3397
Practice Address - Country:US
Practice Address - Phone:612-874-0705
Practice Address - Fax:612-874-0713
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN587493900Medicaid
MN587493900Medicaid
MN350004023Medicare PIN