Provider Demographics
NPI:1255655833
Name:INNATE HEALTH AND WELLNESS PC
Entity Type:Organization
Organization Name:INNATE HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-516-1688
Mailing Address - Street 1:930 IL ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-1905
Mailing Address - Country:US
Mailing Address - Phone:847-516-1688
Mailing Address - Fax:847-516-9269
Practice Address - Street 1:930 IL ROUTE 22
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1905
Practice Address - Country:US
Practice Address - Phone:847-516-1688
Practice Address - Fax:847-516-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty