Healthcare Provider Details

I. General information

NPI: 1801945902
Provider Name (Legal Business Name): CARL PAUL MAKUTA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 SUNBURY ST
MINERSVILLE PA
17954-1345
US

IV. Provider business mailing address

237 SUNBURY ST
MINERSVILLE PA
17954-1345
US

V. Phone/Fax

Practice location:
  • Phone: 570-544-3056
  • Fax: 570-544-3056
Mailing address:
  • Phone: 570-544-3056
  • Fax: 570-544-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001879L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: