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General NPI Number Information
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NPI Number | 1831602630
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Entity Type | Organization
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Legal Business Name | INNATE LIFE LLC
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 101 SUTTON CIR
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City | MOORE
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State | OK
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Zip | 73160-4602
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Country | US
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Telephone | 405-799-2300
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Fax | 405-799-2360
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Provider Business Mailing Address
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Address Line | 101 SUTTON CIR
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City | MOORE
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State | OK
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Zip | 73160-4602
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Country | US
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Telephone | 405-799-2300
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Fax | 405-799-2360
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. BRIANA WINDHAM
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Credential | DC
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Telephone | 405-799-2300
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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 | 4227
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License Number State | OK
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