Healthcare Provider Details

I. General information

NPI: 1043558489
Provider Name (Legal Business Name): INNATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S WESTERN AVE STE. 101
SIOUX FALLS SD
57105-6589
US

IV. Provider business mailing address

3801 S WESTERN AVE STE. 101
SIOUX FALLS SD
57105-6589
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-4337
  • Fax: 877-256-0827
Mailing address:
  • Phone: 605-334-4337
  • Fax: 877-256-0827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1069
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number1069
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1069
License Number StateSD

VIII. Authorized Official

Name: DR. JENNY ANNE MILLER
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 605-334-4337