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General NPI Number Information
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NPI Number | 1295105716
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Entity Type | Organization
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Legal Business Name | MAK WELLNESS SOLUTIONS LLC
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Dates
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Enumeration Date | 09/26/2015
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 88 RYDERS LN SUITE 101
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City | STRATFORD
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State | CT
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Zip | 06614
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Country | US
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Telephone | 203-375-1101
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Fax | 203-375-1212
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Provider Business Mailing Address
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Address Line | 88 RYDERS LN SUITE 101
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City | STRATFORD
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State | CT
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Zip | 06614-1666
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Country | US
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Telephone | 203-375-1101
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Fax | 203-375-1212
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK ANTHONY KONOPKA
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Credential | D.C.
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Telephone | 203-375-1101
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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 | 001999
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License Number State | CT
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