Organization
CANNON CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY W CANNON D.C., M.S. (CHIROPRACTIC PHYSICIAN, OWNER)
(208) 557-1880
Entity
Organization
Contact information
Practice address
2052 JENNIE LEE DR, SUITE 4, IDAHO FALLS, ID 83404-7047
(208) 557-1880
(208) 874-4273
Mailing address
2052 JENNIE LEE DR, SUITE 4, IDAHO FALLS, ID 83404-7047
(208) 557-1880
(208) 874-4273
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
CHIA-1580
ID
Other
Enumeration date
06/24/2014
Last updated
06/24/2014
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