Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12708 | TX |
NPI | 1003226721 |
---|---|
Provider Name | Dr. Ashley Mayes |
First Address | Longview, TX 75608-5695 |
Second Address | Longview, TX 75605-7076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 28/09/2020 |