Provider Demographics
NPI:1215011044
Name:MAKI, MATTHEW AUGUST (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:AUGUST
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 1:6505 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-4253
Mailing Address - Country:US
Mailing Address - Phone:507-263-3925
Mailing Address - Fax:507-263-5065
Practice Address - Street 1:6505 CEDAR HILLS DR
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-4253
Practice Address - Country:US
Practice Address - Phone:507-263-3925
Practice Address - Fax:507-263-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4074111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01N80MAOtherBLUE CROSS BLUE SHIELD
MNP00222515Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MNU91735Medicare UPIN