Provider Demographics
NPI:1184801110
Name:IRA CHIRO PC
Entity type:Organization
Organization Name:IRA CHIRO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-725-7000
Mailing Address - Street 1:8806 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:IRA
Mailing Address - State:MI
Mailing Address - Zip Code:48023-2473
Mailing Address - Country:US
Mailing Address - Phone:586-725-7000
Mailing Address - Fax:
Practice Address - Street 1:8806 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:IRA
Practice Address - State:MI
Practice Address - Zip Code:48023-2473
Practice Address - Country:US
Practice Address - Phone:586-725-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS007675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER
=========OtherTAX ID NUMBER
MI0N60030Medicare PIN