Provider Demographics
NPI:1043558489
Name:INNATE INC
Entity Type:Organization
Organization Name:INNATE INC
Other - Org Name:INNATE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-334-4337
Mailing Address - Street 1:3801 S WESTERN AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6589
Mailing Address - Country:US
Mailing Address - Phone:605-334-4337
Mailing Address - Fax:877-256-0827
Practice Address - Street 1:3801 S WESTERN AVE
Practice Address - Street 2:STE. 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6589
Practice Address - Country:US
Practice Address - Phone:605-334-4337
Practice Address - Fax:877-256-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1069111N00000X, 111NP0017X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty