=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568330769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERSIDE CHIROPRACTIC CENTER MAK PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3657 VAN BUREN BLVD
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-4249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-895-1913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3657 VAN BUREN BLVD
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92503-4249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-895-1913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CHUN KEUNG MAK
-----------------------------------------------------
Credential | DC, QME, CCSP, EMT
-----------------------------------------------------
Telephone | 562-895-1913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------