Provider Demographics
NPI:1154021475
Name:INNOVE CHIRO AND REHAB, PLLC
Entity type:Organization
Organization Name:INNOVE CHIRO AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNOCK
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:563-249-7446
Mailing Address - Street 1:224 SE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1020
Mailing Address - Country:US
Mailing Address - Phone:563-249-7446
Mailing Address - Fax:954-827-0697
Practice Address - Street 1:224 SE 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1020
Practice Address - Country:US
Practice Address - Phone:563-249-7446
Practice Address - Fax:954-827-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty