Provider Demographics
NPI:1023294709
Name:MAKANA WELLNESS, INC.
Entity type:Organization
Organization Name:MAKANA WELLNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-594-0071
Mailing Address - Street 1:4740 FLINTRIDGE DR
Mailing Address - Street 2:SUITE 216
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4253
Mailing Address - Country:US
Mailing Address - Phone:719-594-0071
Mailing Address - Fax:719-260-1964
Practice Address - Street 1:4740 FLINTRIDGE DR
Practice Address - Street 2:SUITE 216
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4253
Practice Address - Country:US
Practice Address - Phone:719-594-0071
Practice Address - Fax:719-260-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-13
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811539Medicare PIN