Provider Demographics
NPI:1972875565
Name:MACK CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:MACK CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-410-3925
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0668
Mailing Address - Country:US
Mailing Address - Phone:352-622-1136
Mailing Address - Fax:352-622-8544
Practice Address - Street 1:1813 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8167
Practice Address - Country:US
Practice Address - Phone:352-622-1136
Practice Address - Fax:352-622-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty