Provider Demographics
NPI:1144751413
Name:INNATE HEALTH, LLC
Entity Type:Organization
Organization Name:INNATE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-792-4600
Mailing Address - Street 1:715 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2534
Mailing Address - Country:US
Mailing Address - Phone:712-792-4600
Mailing Address - Fax:712-792-7775
Practice Address - Street 1:715 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2534
Practice Address - Country:US
Practice Address - Phone:712-792-4600
Practice Address - Fax:712-792-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty