Healthcare Provider Details

I. General information

NPI: 1124874854
Provider Name (Legal Business Name): IGNITE CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16082 METCALF AVE
OVERLAND PARK KS
66085-9249
US

IV. Provider business mailing address

3121 S 11TH ST # NE68502
LINCOLN NE
68502-4416
US

V. Phone/Fax

Practice location:
  • Phone: 402-470-7050
  • Fax:
Mailing address:
  • Phone: 402-470-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS JOHN BANGERT
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 402-470-7050