Individual
DR. IRA CANADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
E.D.D
Contact information
Practice address
1510 ANDERSON AVE, CHATTANOOGA, TN 37404-4204
(678) 862-2178
Mailing address
1510 ANDERSON AVE, CHATTANOOGA, TN 37404-4204
(678) 862-2178
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
000549759
TN
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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