Provider Demographics
NPI:1942680681
Name:INNATE LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:INNATE LIFE CHIROPRACTIC, LLC
Other - Org Name:INNATE LIFE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-886-8123
Mailing Address - Street 1:6249 S EAST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2091
Mailing Address - Country:US
Mailing Address - Phone:317-886-8123
Mailing Address - Fax:317-788-1156
Practice Address - Street 1:6249 S EAST ST
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2091
Practice Address - Country:US
Practice Address - Phone:317-886-8123
Practice Address - Fax:317-788-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty