Provider Demographics
NPI:1790252096
Name:INNATE CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:INNATE CHIROPRACTIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DOUDNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-260-1635
Mailing Address - Street 1:3536 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2223
Mailing Address - Country:US
Mailing Address - Phone:740-260-1635
Mailing Address - Fax:
Practice Address - Street 1:3536 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2223
Practice Address - Country:US
Practice Address - Phone:740-260-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1457826497Medicaid