Provider Demographics
NPI:1497311310
Name:IGNITE SPINE AND SPORTS LLC
Entity Type:Organization
Organization Name:IGNITE SPINE AND SPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-795-1999
Mailing Address - Street 1:2692 FARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1326
Mailing Address - Country:US
Mailing Address - Phone:908-795-1999
Mailing Address - Fax:
Practice Address - Street 1:571 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-795-1999
Practice Address - Fax:908-279-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty