Provider Demographics
NPI:1851628275
Name:INNATE PC
Entity Type:Organization
Organization Name:INNATE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-223-6613
Mailing Address - Street 1:1033 BASIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6649
Mailing Address - Country:US
Mailing Address - Phone:701-223-6613
Mailing Address - Fax:701-221-9114
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-223-6613
Practice Address - Fax:701-221-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty