Provider Demographics
NPI:1063961779
Name:MAKI CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MAKI CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-347-1137
Mailing Address - Street 1:607 COUNTY ROAD 10 NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2373
Mailing Address - Country:US
Mailing Address - Phone:763-432-3921
Mailing Address - Fax:
Practice Address - Street 1:607 COUNTY ROAD 10 NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2373
Practice Address - Country:US
Practice Address - Phone:763-432-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty