Provider Demographics
NPI:1578172003
Name:INNATE ENTERPRISE PLLC
Entity Type:Organization
Organization Name:INNATE ENTERPRISE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WESTHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:980-202-2890
Mailing Address - Street 1:2501B PLANTATION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5298
Mailing Address - Country:US
Mailing Address - Phone:980-202-2890
Mailing Address - Fax:
Practice Address - Street 1:2501B PLANTATION CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5298
Practice Address - Country:US
Practice Address - Phone:980-202-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty