Provider Demographics
NPI:1548698665
Name:INNATE FUSION, PC
Entity type:Organization
Organization Name:INNATE FUSION, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-242-0030
Mailing Address - Street 1:380 MAPLE AVE W
Mailing Address - Street 2:SUITE L3
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5620
Mailing Address - Country:US
Mailing Address - Phone:703-242-0030
Mailing Address - Fax:
Practice Address - Street 1:380 MAPLE AVE W
Practice Address - Street 2:SUITE L3
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5620
Practice Address - Country:US
Practice Address - Phone:703-242-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557018111NI0013X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty