Healthcare Provider Details

I. General information

NPI: 1184801110
Provider Name (Legal Business Name): IRA CHIRO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 DIXIE HWY
IRA MI
48023-2473
US

IV. Provider business mailing address

8806 DIXIE HWY
IRA MI
48023-2473
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-7000
  • Fax:
Mailing address:
  • Phone: 586-725-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberSS007675
License Number StateMI

VIII. Authorized Official

Name: STEPHEN SMITH
Title or Position: OWNER
Credential: DC
Phone: 586-725-7000