Provider Demographics
NPI:1609258219
Name:INNATE CHIROPRACTIC HEALTH, LLC
Entity Type:Organization
Organization Name:INNATE CHIROPRACTIC HEALTH, LLC
Other - Org Name:INNATE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-334-4337
Mailing Address - Street 1:3801 S WESTERN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6589
Mailing Address - Country:US
Mailing Address - Phone:605-334-4337
Mailing Address - Fax:877-256-0827
Practice Address - Street 1:3801 S WESTERN AVE
Practice Address - Street 2:STE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6589
Practice Address - Country:US
Practice Address - Phone:605-334-4337
Practice Address - Fax:877-256-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1730426875OtherNPI
SD1730426875OtherNPI