MEDICARE: INNATE HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1073916508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNATE HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	6220 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1904
Country	:	US
Telephone Number	:	954-489-4790
Fax Number	:	954-489-9773

Provider Business Practice Location Address
First Line	:	6220 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1904
Country	:	US
Telephone Number	:	954-489-4790
Fax Number	:	954-489-9773

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CORY SCOTT HENNESSEY
Credential	:	DC
Telephone Number	:	954-489-4790

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	07/10/2015

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