Provider Demographics
NPI:1750404323
Name:MCMAKIN, CAROLYN (MA, DC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MCMAKIN
Suffix:
Gender:F
Credentials:MA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3750
Mailing Address - Country:US
Mailing Address - Phone:503-860-2749
Mailing Address - Fax:360-695-1599
Practice Address - Street 1:5736 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3750
Practice Address - Country:US
Practice Address - Phone:503-860-2749
Practice Address - Fax:360-695-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR48775Medicare UPIN