Provider Demographics
NPI:1033153622
Name:INNATE, INC.
Entity type:Organization
Organization Name:INNATE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-892-4008
Mailing Address - Street 1:217 GILMAN ST.
Mailing Address - Street 2:P.O. BOX 520
Mailing Address - City:SHEFFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50475-0520
Mailing Address - Country:US
Mailing Address - Phone:641-892-4008
Mailing Address - Fax:641-892-4662
Practice Address - Street 1:217 GILMAN ST.
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:IA
Practice Address - Zip Code:50475
Practice Address - Country:US
Practice Address - Phone:641-892-4008
Practice Address - Fax:641-892-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0726851Medicaid
IAI17893Medicare PIN
IA0726851Medicaid