Provider Demographics
NPI:1609207380
Name:MAKOVEC, JAY (DC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:MAKOVEC
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 1:1019 RIVER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9181
Mailing Address - Country:US
Mailing Address - Phone:608-424-1840
Mailing Address - Fax:608-424-1815
Practice Address - Street 1:1019 RIVER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9181
Practice Address - Country:US
Practice Address - Phone:608-424-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4986-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor