Provider Demographics
NPI:1093103475
Name:IGNITE LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:IGNITE LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:775-738-5406
Mailing Address - Street 1:780 W SILVER ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3819
Mailing Address - Country:US
Mailing Address - Phone:775-738-5406
Mailing Address - Fax:775-375-5401
Practice Address - Street 1:780 W SILVER ST
Practice Address - Street 2:SUITE 112
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3819
Practice Address - Country:US
Practice Address - Phone:775-738-5406
Practice Address - Fax:775-375-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty