Provider Demographics
NPI:1144754672
Name:CANNON, DANIEL (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CANNON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-5889
Mailing Address - Country:US
Mailing Address - Phone:334-701-8451
Mailing Address - Fax:334-821-1204
Practice Address - Street 1:161 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5889
Practice Address - Country:US
Practice Address - Phone:334-701-8451
Practice Address - Fax:334-821-1204
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer