Healthcare Provider Details

I. General information

NPI: 1306181268
Provider Name (Legal Business Name): CANADA CHIROPRACTIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD SUITE 175
MURRAY UT
84107-6159
US

IV. Provider business mailing address

5801 S FASHION BLVD SUITE 175
MURRAY UT
84107-6159
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-3444
  • Fax:
Mailing address:
  • Phone: 385-202-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number287808-1202
License Number StateUT

VIII. Authorized Official

Name: DR. ANGELA D CANADA
Title or Position: OWNER
Credential: DC
Phone: 801-913-5178