Provider Demographics
NPI:1164798542
Name:CANON, PAMELA S (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:CANON
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 1ST AVE W PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-2808
Mailing Address - Country:US
Mailing Address - Phone:406-208-0280
Mailing Address - Fax:844-442-7766
Practice Address - Street 1:20 1ST AVE W
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-2808
Practice Address - Country:US
Practice Address - Phone:406-208-0280
Practice Address - Fax:406-969-1241
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-170171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist