Provider Demographics
NPI:1619007010
Name:MAKI, PAUL MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
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 1:227 GRANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734
Mailing Address - Country:US
Mailing Address - Phone:218-744-1910
Mailing Address - Fax:218-744-5397
Practice Address - Street 1:227 GRANT AVENUE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734
Practice Address - Country:US
Practice Address - Phone:218-744-1910
Practice Address - Fax:218-744-5397
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
604638OtherACN GROUP
63D18EVOtherBLUE CROSS BLUE SHIELD
U73801Medicare UPIN