Provider Demographics
NPI:1972854685
Name:INNATE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:INNATE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROK
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-443-2635
Mailing Address - Street 1:210 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:S PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2424
Mailing Address - Country:US
Mailing Address - Phone:207-775-7468
Mailing Address - Fax:
Practice Address - Street 1:210 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:S PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2424
Practice Address - Country:US
Practice Address - Phone:207-775-7468
Practice Address - Fax:207-775-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty