Provider Demographics
NPI:1902357320
Name:INNATE CHIROPRACTIC - PLLC
Entity Type:Organization
Organization Name:INNATE CHIROPRACTIC - PLLC
Other - Org Name:EPIC FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:TORRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-278-2038
Mailing Address - Street 1:869 HIGHWAY 105 EXT STE 9
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4958
Mailing Address - Country:US
Mailing Address - Phone:828-278-2038
Mailing Address - Fax:
Practice Address - Street 1:869 HIGHWAY 105 EXT STE 9
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4958
Practice Address - Country:US
Practice Address - Phone:828-278-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty