1083734842 NPI number — DR. TONJA L MANSFIELD LOFTIS DC

Table of content: DR. TONJA L MANSFIELD LOFTIS DC (NPI 1083734842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083734842 NPI number — DR. TONJA L MANSFIELD LOFTIS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANSFIELD LOFTIS
Provider First Name:
TONJA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANSFIELD
Provider Other First Name:
TONJA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083734842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4505 ROBIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79707-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-697-1643
Provider Business Mailing Address Fax Number:
432-694-7939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4107 W ILLINOIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79703-5526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-697-1643
Provider Business Practice Location Address Fax Number:
432-694-7939
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9463 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)