Healthcare Provider Details

I. General information

NPI: 1215401849
Provider Name (Legal Business Name): IGNITE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 BRYAN RD STE 111
DARDENNE PRAIRIE MO
63368-4801
US

IV. Provider business mailing address

137 SHADOW POINTE DR
WENTZVILLE MO
63385-3685
US

V. Phone/Fax

Practice location:
  • Phone: 314-800-8609
  • Fax: 636-385-6507
Mailing address:
  • Phone: 314-800-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAKE WAYNE SMITH
Title or Position: OWNER, CHIROPRACTIC PHYSICIAN
Credential: DC, MS, BS
Phone: 636-385-6506