Provider Demographics
NPI:1073812533
Name:CANNON, ANNETTE N (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:N
Last Name:CANNON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 W 50TH ST
Mailing Address - Street 2:SUITE 250-B
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2047
Mailing Address - Country:US
Mailing Address - Phone:612-787-2173
Mailing Address - Fax:
Practice Address - Street 1:3801 W 50TH ST
Practice Address - Street 2:SUITE 250-B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2047
Practice Address - Country:US
Practice Address - Phone:612-787-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor