Provider Demographics
NPI:1194701896
Name:MAKEETA, QUATI (DC)
Entity type:Individual
Prefix:DR
First Name:QUATI
Middle Name:
Last Name:MAKEETA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10214 N TATUM BLVD STE A1500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4203
Mailing Address - Country:US
Mailing Address - Phone:602-808-8828
Mailing Address - Fax:
Practice Address - Street 1:10214 N TATUM BLVD STE A1500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4203
Practice Address - Country:US
Practice Address - Phone:602-808-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008785111N00000X
AZ3913111N00000X
AZ7227111N00000X
MA2688111N00000X
PAAI008658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z70002Medicare ID - Type Unspecified
U90006Medicare UPIN