Provider Demographics
NPI:1801945902
Name:MAKUTA, CARL PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:PAUL
Last Name:MAKUTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1345
Mailing Address - Country:US
Mailing Address - Phone:570-544-3056
Mailing Address - Fax:570-544-3056
Practice Address - Street 1:237 SUNBURY ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1345
Practice Address - Country:US
Practice Address - Phone:570-544-3056
Practice Address - Fax:570-544-3056
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001879L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor