Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4074 | MN |
NPI | 1215011044 |
---|---|
Provider Name | Dr. Matthew August Maki |
First Address | Cannon Falls, MN 55009-4253 |
Second Address | Cannon Falls, MN 55009-4253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01N80MA | BLUE CROSS BLUE SHIELD (01) | MN |
U91735 | (02) | MN |