MEDICARE: IRA CHIRO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	SS007675	MI

General Provider Information

NPI Number	:	1184801110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRA CHIRO PC

Provider Business Mailing Address
First Line	:	8806 DIXIE HWY
Second Line	:
City	:	IRA
State	:	MI
Zip	:	48023-2473
Country	:	US
Telephone Number	:	586-725-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	8806 DIXIE HWY
Second Line	:
City	:	IRA
State	:	MI
Zip	:	48023-2473
Country	:	US
Telephone Number	:	586-725-7000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN SMITH
Credential	:	DC
Telephone Number	:	586-725-7000

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	04/20/2008

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Directions to “IRA CHIRO PC ” Practice Location

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