Provider Demographics
NPI:1639627367
Name:INNATE HEALTH FAMILY CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:INNATE HEALTH FAMILY CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAGUZO
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANINIBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-406-1200
Mailing Address - Street 1:14886 US HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3217
Mailing Address - Country:US
Mailing Address - Phone:910-406-1200
Mailing Address - Fax:910-406-1201
Practice Address - Street 1:14886 US HIGHWAY 17 N
Practice Address - Street 2:APT 203
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3217
Practice Address - Country:US
Practice Address - Phone:910-406-1200
Practice Address - Fax:910-406-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730631052OtherUNKNOWN