Provider Demographics
NPI:1689988495
Name:INNOVATIVE HEALTH LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RITZENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-355-4224
Mailing Address - Street 1:2114 SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2365
Mailing Address - Country:US
Mailing Address - Phone:715-355-4224
Mailing Address - Fax:715-355-4120
Practice Address - Street 1:2114 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2365
Practice Address - Country:US
Practice Address - Phone:715-355-4224
Practice Address - Fax:715-355-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3727261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center