Individual
TIMOTHY WADE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
611 ENSIGN DR, AMMON, ID 83406-4777
(208) 557-1880
Mailing address
611 ENSIGN DR, AMMON, ID 83406-4777
(208) 557-1880
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1580
ID
Other
Enumeration date
01/03/2014
Last updated
02/09/2017
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