Provider Demographics
NPI:1669829503
Name:IGNITE CHIROPRACTIC, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IGNITE CHIROPRACTIC, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHSUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-640-3893
Mailing Address - Street 1:5050 TIMBER PKWY S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4810
Mailing Address - Country:US
Mailing Address - Phone:701-640-3893
Mailing Address - Fax:
Practice Address - Street 1:5050 TIMBER PKWY S
Practice Address - Street 2:SUITE 120
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4810
Practice Address - Country:US
Practice Address - Phone:701-640-3893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty