Provider Demographics
NPI:1912366154
Name:INNATE EXPRESSION
Entity Type:Organization
Organization Name:INNATE EXPRESSION
Other - Org Name:COLM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COLM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-226-2975
Mailing Address - Street 1:5920 W WILLIAM CANNON DR
Mailing Address - Street 2:BUILDING 7, SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1902
Mailing Address - Country:US
Mailing Address - Phone:512-956-7449
Mailing Address - Fax:512-727-0394
Practice Address - Street 1:5920 W WILLIAM CANNON DR
Practice Address - Street 2:BUILDING 7, SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1902
Practice Address - Country:US
Practice Address - Phone:512-956-7449
Practice Address - Fax:512-727-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty