Innate Life LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

INNATE LIFE LLC

Practice address

1338 N 4TH St
Tomahawk, WI 54487-2137

Phone

(171) 545-3536

NPI assigned

Jan 3, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelley Milcarek, DCNPI 1255868550

Title

Owner

Phone

(715) 453-5365

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Innate Life Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelley R Milcarek, DC

  • Chiropractor
  • Tomahawk, WI
  • NPI 1255868550
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1972216166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 351",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544870351",
            "telephone_number": "171-545-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1338 N 4TH ST",
            "city": "TOMAHAWK",
            "state": "WI",
            "postal_code": "544872137",
            "telephone_number": "171-545-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNATE LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "MILCAREK",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-453-5365",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255868550",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innate Life",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innate Life",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dean R Hussong, DDS
• Joshua Drew Ice, LAT
• Victor Ierulli, MD
• Robert David Imm, DDS
• Amy Marie Imme
• Jean Rene Jarvis, RN
• R Heidi Jarvis
• William Wayne Jones
• David D Kim, MD
• Catherine Marie Koth, PTA

• Chiropractor in Tomahawk, WI
• Providers in Tomahawk, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.