Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH000496 | FL |
NPI | 1437187721 |
---|---|
Provider Name | Dr. Mark T Machuga |
First Address | Gotha, FL 34734-4902 |
Second Address | Ocoee, FL 34761-2986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 31/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050497100 | (05) | FL |
T84508 | (02) | FL |