Provider Demographics
NPI:1164967758
Name:IGNITE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:IGNITE CHIROPRACTIC PC
Other - Org Name:YOUR FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NEVSIMAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-251-0704
Mailing Address - Street 1:323 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55964-1255
Mailing Address - Country:US
Mailing Address - Phone:507-534-2600
Mailing Address - Fax:507-534-4373
Practice Address - Street 1:323 W BROADWAY
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:MN
Practice Address - Zip Code:55964-1255
Practice Address - Country:US
Practice Address - Phone:507-534-2600
Practice Address - Fax:507-534-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6029261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service