Provider Demographics
NPI:1831569813
Name:INNATE CONCEPTS CHIROPRACTIC
Entity type:Organization
Organization Name:INNATE CONCEPTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-951-9447
Mailing Address - Street 1:2323 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-3344
Mailing Address - Country:US
Mailing Address - Phone:847-951-9447
Mailing Address - Fax:
Practice Address - Street 1:668 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3364
Practice Address - Country:US
Practice Address - Phone:847-577-2660
Practice Address - Fax:847-577-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227016247261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center