Provider Demographics
NPI:1093940090
Name:INNATE CHIROPRACTIC AND CHILDREN WELLNESS
Entity Type:Organization
Organization Name:INNATE CHIROPRACTIC AND CHILDREN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:JEE-EUN
Authorized Official - Last Name:RHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-838-4484
Mailing Address - Street 1:236 S. EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-795-7711
Mailing Address - Fax:626-795-2145
Practice Address - Street 1:236 S. EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-795-7711
Practice Address - Fax:626-795-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty