Provider Demographics
NPI:1033668728
Name:MAKI, LANCE (DC)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:MAKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 COUNTY ROAD 10 NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2373
Mailing Address - Country:US
Mailing Address - Phone:763-432-3921
Mailing Address - Fax:
Practice Address - Street 1:607 COUNTY ROAD 10 NE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2373
Practice Address - Country:US
Practice Address - Phone:763-432-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor