Healthcare Provider Details

I. General information

NPI: 1003259813
Provider Name (Legal Business Name): INNATE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 08/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 CASCADE RD SE SUITE 200
GRAND RAPIDS MI
49546-6887
US

IV. Provider business mailing address

45 BENJAMIN AVE NE
GRAND RAPIDS MI
49503-3775
US

V. Phone/Fax

Practice location:
  • Phone: 616-295-5699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number2301010075
License Number StateMI

VIII. Authorized Official

Name: DR. JUSTIN KEFFER
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: DC
Phone: 616-295-5699