Provider Demographics
NPI:1497487177
Name:ESSENTIALLY INNATE CHIROPRACTIC & WELLNESS, PC
Entity Type:Organization
Organization Name:ESSENTIALLY INNATE CHIROPRACTIC & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF ESSENTIALLY INNATE CHI
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:308-270-1240
Mailing Address - Street 1:812 COURT ST STE B
Mailing Address - Street 2:
Mailing Address - City:GIBBON
Mailing Address - State:NE
Mailing Address - Zip Code:68840-3117
Mailing Address - Country:US
Mailing Address - Phone:308-270-1240
Mailing Address - Fax:308-270-1245
Practice Address - Street 1:812 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:GIBBON
Practice Address - State:NE
Practice Address - Zip Code:68840-3117
Practice Address - Country:US
Practice Address - Phone:308-270-1240
Practice Address - Fax:308-270-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027039200Medicaid