Provider Demographics
NPI:1013571991
Name:IGNITE FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:IGNITE FAMILY CHIROPRACTIC PC
Other - Org Name:MOSIER/TIMPERLEY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKNASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-604-0711
Mailing Address - Street 1:4645 NORMAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5823
Mailing Address - Country:US
Mailing Address - Phone:402-483-6633
Mailing Address - Fax:
Practice Address - Street 1:4645 NORMAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5823
Practice Address - Country:US
Practice Address - Phone:402-483-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1750840302Medicaid