Provider Demographics
NPI:1700131877
Name:MAK CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:MAK CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD-ALI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOLAILAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-203-7625
Mailing Address - Street 1:1818 E BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6106
Mailing Address - Country:US
Mailing Address - Phone:972-203-7625
Mailing Address - Fax:972-203-7818
Practice Address - Street 1:1818 E BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6106
Practice Address - Country:US
Practice Address - Phone:972-203-7625
Practice Address - Fax:972-203-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty