Provider Demographics
NPI:1992742472
Name:MAYES CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:MAYES CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-938-1710
Mailing Address - Street 1:3819 4 MILE RD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9344
Mailing Address - Country:US
Mailing Address - Phone:231-938-1710
Mailing Address - Fax:231-938-1173
Practice Address - Street 1:3819 4 MILE RD N
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9344
Practice Address - Country:US
Practice Address - Phone:231-938-1710
Practice Address - Fax:231-938-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU80752Medicare UPIN
MI0N91120Medicare ID - Type Unspecified