Provider Demographics
NPI:1073623146
Name:CANNONE, LEONARD (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:CANNONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:LEONARDO
Other - Middle Name:
Other - Last Name:CANNONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2185 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6024
Mailing Address - Country:US
Mailing Address - Phone:510-352-6033
Mailing Address - Fax:510-352-6034
Practice Address - Street 1:2185 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-6024
Practice Address - Country:US
Practice Address - Phone:510-352-6033
Practice Address - Fax:510-352-6034
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0247040Medicare ID - Type Unspecified