Healthcare Provider Details

I. General information

NPI: 1164967758
Provider Name (Legal Business Name): IGNITE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W BROADWAY
PLAINVIEW MN
55964-1255
US

IV. Provider business mailing address

323 W BROADWAY
PLAINVIEW MN
55964-1255
US

V. Phone/Fax

Practice location:
  • Phone: 507-534-2600
  • Fax: 507-534-4373
Mailing address:
  • Phone: 507-534-2600
  • Fax: 507-534-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number6029
License Number StateMN

VIII. Authorized Official

Name: DR. MELISSA SUE NEVSIMAL
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 507-251-0704