Basic Information
| Provider Information | |||||||||
| NPI: | 1952604662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYO | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.C./L.M.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 AIRPORT WAY STE 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074792331 | ||||||||
| FaxNumber: | 9074790164 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 AIRPORT WAY STE 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074792331 | ||||||||
| FaxNumber: | 9074790164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2010 | ||||||||
| LastUpdateDate: | 04/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 033885 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 111N00000X | 525 | AK | Y | Chiropractic Providers | Chiropractor |
No ID Information.