Provider Demographics
NPI:1144909375
Name:MACKES, JOEL K
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:K
Last Name:MACKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 WILDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6767
Mailing Address - Country:US
Mailing Address - Phone:949-394-3624
Mailing Address - Fax:
Practice Address - Street 1:16-590 OLD VOLCANO RD
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8158
Practice Address - Country:US
Practice Address - Phone:408-809-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor