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General NPI Number Information
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NPI Number | 1831569813
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Entity Type | Organization
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Legal Business Name | INNATE CONCEPTS CHIROPRACTIC
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 668 E NORTHWEST HWY
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3364
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Country | US
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Telephone | 847-577-2660
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Fax | 847-577-2661
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Provider Business Mailing Address
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Address Line | 2323 GLENMOOR DR
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City | WEST DUNDEE
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State | IL
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Zip | 60118-3344
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Country | US
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Telephone | 847-951-9447
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | DANA MARIE CAPOBIANCO
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Credential |
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Telephone | 847-951-9447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 227016247
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License Number State | IL
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