Provider Demographics
NPI:1770027658
Name:INNER HEALTH SYSTEMS P.C.
Entity Type:Organization
Organization Name:INNER HEALTH SYSTEMS P.C.
Other - Org Name:INNER HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NELSON JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-359-9541
Mailing Address - Street 1:2406 E 53RD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3827
Mailing Address - Country:US
Mailing Address - Phone:563-344-3909
Mailing Address - Fax:563-344-3914
Practice Address - Street 1:2406 E 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3827
Practice Address - Country:US
Practice Address - Phone:563-344-3909
Practice Address - Fax:563-344-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty