Provider Demographics
NPI:1538879945
Name:NICHOLAS CANNON DC PC
Entity type:Organization
Organization Name:NICHOLAS CANNON DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-324-1790
Mailing Address - Street 1:152 MAPLE ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1168
Mailing Address - Country:US
Mailing Address - Phone:802-342-1790
Mailing Address - Fax:
Practice Address - Street 1:152 MAPLE ST STE 302
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1168
Practice Address - Country:US
Practice Address - Phone:802-342-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty