Provider Demographics
NPI:1437187721
Name:MACHUGA, MARK T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:MACHUGA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2235 LAKE NALLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-4902
Mailing Address - Country:US
Mailing Address - Phone:407-877-9771
Mailing Address - Fax:407-877-8505
Practice Address - Street 1:1554 BOREN DR
Practice Address - Street 2:STE 300
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2986
Practice Address - Country:US
Practice Address - Phone:407-877-9771
Practice Address - Fax:407-877-8505
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH000496111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050497100Medicaid
FLT84508Medicare UPIN
FL050497100Medicaid