MEDICARE: DR. ANGELA D CANADA D.C.

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	287808-1202	UT

General Provider Information

NPI Number	:	1275885055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA D CANADA D.C.

Provider Business Mailing Address
First Line	:	1473 S 600 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2062
Country	:	US
Telephone Number	:	801-487-1010
Fax Number	:	801-487-1015

Provider Business Practice Location Address
First Line	:	1473 S 600 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2062
Country	:	US
Telephone Number	:	801-487-1010
Fax Number	:	801-487-1015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	02/13/2019

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