Basic Information
Provider Information
NPI: 1003141656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAKAREWICZ
FirstName: BEAU
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 668
Address2:  
City: OCALA
State: FL
PostalCode: 344780668
CountryCode: US
TelephoneNumber: 3526221136
FaxNumber: 3526228544
Practice Location
Address1: 1813 SW 1ST AVE
Address2:  
City: OCALA
State: FL
PostalCode: 344718167
CountryCode: US
TelephoneNumber: 3526221136
FaxNumber: 3526228544
Other Information
ProviderEnumerationDate: 10/14/2009
LastUpdateDate: 08/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X9782FLY Chiropractic ProvidersChiropractor 

No ID Information.


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