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General NPI Number Information
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NPI Number | 1114154457
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Entity Type | Organization
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Legal Business Name | MARK T MACHUGA P A
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Dates
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Enumeration Date | 06/13/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 1554 BOREN DR STE 300
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City | OCOEE
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State | FL
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Zip | 34761-2986
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Country | US
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Telephone | 407-877-9771
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Fax | 407-877-8505
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Provider Business Mailing Address
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Address Line | 1554 BOREN DR STE 300
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City | OCOEE
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State | FL
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Zip | 34761-2986
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Country | US
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Telephone | 407-877-9771
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Fax | 407-877-8505
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK T MACHUGA
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Credential | D.C.
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Telephone | 407-877-9771
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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 | CH0004967
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License Number State | FL
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