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General NPI Number Information
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NPI Number | 1386244283
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Entity Type | Organization
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Legal Business Name | INNATE HEALTH CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 6 HAWKEYE DR STE 105
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8904
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Country | US
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Telephone | 563-508-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 4TH ST APT 9
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City | MOLINE
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State | IL
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Zip | 61265-5965
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN WEINTRAUB
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Credential |
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Telephone | 563-508-5358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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