Provider Demographics
NPI:1063218055
Name:INNATE HOLDINGS LLC
Entity type:Organization
Organization Name:INNATE HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINTEZ
Authorized Official - Middle Name:JUWAN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-367-5104
Mailing Address - Street 1:607 W 5TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6166
Mailing Address - Country:US
Mailing Address - Phone:843-873-0011
Mailing Address - Fax:
Practice Address - Street 1:8 DAVIS KEATS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6509
Practice Address - Country:US
Practice Address - Phone:864-214-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty