Individual
DR. CHAD JACOB CANNON
Active
Individual
DR. CHAD JACOB CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
7875588-1202
UT
111NR0400X
Rehabilitation Chiropractor
Primary
15645
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15645
CHIROPRACTIC LICENSE
TX
01
—
7875588-1202
CHIROPRACTIC LICENSE
UT
Enumeration date
05/16/2013
Last updated
08/03/2023
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