Provider Demographics
NPI:1689915183
Name:INNATE POTENTIAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:INNATE POTENTIAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:504-662-1544
Mailing Address - Street 1:9135 W JUDGE PEREZ DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4516
Mailing Address - Country:US
Mailing Address - Phone:504-662-1544
Mailing Address - Fax:
Practice Address - Street 1:9135 W JUDGE PEREZ DR STE B
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4516
Practice Address - Country:US
Practice Address - Phone:504-662-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1891048344OtherINDIVIDUAL NPI