1609258219 NPI number — INNATE CHIROPRACTIC HEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609258219 NPI number — INNATE CHIROPRACTIC HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNATE CHIROPRACTIC HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609258219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 S WESTERN AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-6589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-334-4337
Provider Business Mailing Address Fax Number:
877-256-0827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 S WESTERN AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-6589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-334-4337
Provider Business Practice Location Address Fax Number:
877-256-0827
Provider Enumeration Date:
06/19/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAAR
Authorized Official First Name:
CASSANDRA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
605-334-4337

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1229 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730426875 . This is a "NPI" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".