=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104461029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNATE HEALTH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2019
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1511 CHAPEL HILL RD.
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-446-2242
-----------------------------------------------------
Fax | 573-446-5575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1511 CHAPEL HILL RD.
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-446-2242
-----------------------------------------------------
Fax | 573-446-5575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NICHOLAS HAGAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 573-446-2242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------