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General NPI Number Information
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NPI Number | 1063961779
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Entity Type | Organization
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Legal Business Name | MAKI CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 607 COUNTY ROAD 10 NE SUITE 104
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City | BLAINE
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State | MN
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Zip | 55434-2373
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Country | US
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Telephone | 763-432-3921
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Fax |
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Provider Business Mailing Address
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Address Line | 607 COUNTY ROAD 10 NE SUITE 104
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City | BLAINE
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State | MN
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Zip | 55434-2373
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Country | US
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Telephone | 763-432-3921
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LANCE MAKI
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Credential | D.C.
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Telephone | 608-347-1137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6368
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License Number State | MN
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