Provider Demographics
NPI:1033713813
Name:INNATE HEALTH & WELLNESS
Entity Type:Organization
Organization Name:INNATE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE REP
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-789-3227
Mailing Address - Street 1:421 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3627
Mailing Address - Country:US
Mailing Address - Phone:609-486-2150
Mailing Address - Fax:609-486-2149
Practice Address - Street 1:421 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3627
Practice Address - Country:US
Practice Address - Phone:609-486-2150
Practice Address - Fax:609-486-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty