Provider Demographics
NPI:1215401849
Name:IGNITE HEALTH, LLC
Entity Type:Organization
Organization Name:IGNITE HEALTH, LLC
Other - Org Name:IGNITE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, BS
Authorized Official - Phone:636-385-6506
Mailing Address - Street 1:137 SHADOW POINTE DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3685
Mailing Address - Country:US
Mailing Address - Phone:314-800-8609
Mailing Address - Fax:
Practice Address - Street 1:1676 BRYAN RD STE 111
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-4801
Practice Address - Country:US
Practice Address - Phone:314-800-8609
Practice Address - Fax:636-385-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty