Individual
CHARLES KELLY CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC, MACOM
Contact information
Practice address
302 E 2ND AVE, MOSIER, OR 97040-1500
(541) 386-8767
Mailing address
PO BOX 312, MOSIER, OR 97040-0312
(541) 386-8767
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC159892
OR
Other
Enumeration date
01/07/2013
Last updated
01/07/2013
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