Provider Demographics
NPI:1295105716
Name:MAK WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:MAK WELLNESS SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KONOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-375-1101
Mailing Address - Street 1:88 RYDERS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1666
Mailing Address - Country:US
Mailing Address - Phone:203-375-1101
Mailing Address - Fax:203-375-1212
Practice Address - Street 1:88 RYDERS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-375-1101
Practice Address - Fax:203-375-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-26
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty