Provider Demographics
NPI:1972556793
Name:MAYFIELD, GREGORY J (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
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 1:2219 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2128
Mailing Address - Country:US
Mailing Address - Phone:318-828-1517
Mailing Address - Fax:318-828-1685
Practice Address - Street 1:2219 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2128
Practice Address - Country:US
Practice Address - Phone:318-828-1517
Practice Address - Fax:318-828-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721372556OtherFED TAX ID #