Provider Demographics
NPI:1740068808
Name:IGNITION LLC
Entity type:Organization
Organization Name:IGNITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRE
Authorized Official - Suffix:
Authorized Official - Credentials:DIPOL OM LAC
Authorized Official - Phone:801-835-8269
Mailing Address - Street 1:131 E 3RD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4773
Mailing Address - Country:US
Mailing Address - Phone:801-835-8269
Mailing Address - Fax:
Practice Address - Street 1:34 S 500 E STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1039
Practice Address - Country:US
Practice Address - Phone:385-422-2720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty