Provider Demographics
NPI:1023782042
Name:INNATE CHIROPRACTIC HEALTHCARE PA
Entity type:Organization
Organization Name:INNATE CHIROPRACTIC HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-803-9341
Mailing Address - Street 1:2555 NE 11TH ST APT 501
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3210
Mailing Address - Country:US
Mailing Address - Phone:201-803-9341
Mailing Address - Fax:
Practice Address - Street 1:7330 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1605
Practice Address - Country:US
Practice Address - Phone:201-803-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty