Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 271605 | OR |
NPI | 1003865981 |
---|---|
Provider Name | Dr. Terrell Ray Cannon |
First Address | Hubbard, OR 97032-9447 |
Second Address | Newport, OR 97365-3646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/07/2007 |