Provider Demographics
NPI:1568478220
Name:CANCARO, DANA STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:STEVEN
Last Name:CANCARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-1179
Mailing Address - Country:US
Mailing Address - Phone:805-466-3643
Mailing Address - Fax:805-466-3296
Practice Address - Street 1:5801 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-466-3643
Practice Address - Fax:805-462-3296
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13964Medicare PIN
T82593Medicare UPIN