Provider Demographics
NPI:1457705238
Name:MAKOS CHIROPRACTIC PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:MAKOS CHIROPRACTIC PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-258-5002
Mailing Address - Street 1:445 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-1434
Mailing Address - Country:US
Mailing Address - Phone:570-258-5002
Mailing Address - Fax:570-904-8838
Practice Address - Street 1:445 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-404-5607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty