Provider Demographics
NPI:1457969768
Name:REIGNITE CHIROPRACTIC
Entity Type:Organization
Organization Name:REIGNITE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:478-320-2197
Mailing Address - Street 1:2717 JOHN HAWKINS PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4026
Mailing Address - Country:US
Mailing Address - Phone:478-320-2197
Mailing Address - Fax:
Practice Address - Street 1:2717 JOHN HAWKINS PKWY STE 107
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4026
Practice Address - Country:US
Practice Address - Phone:478-320-2197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty