Provider Demographics
NPI:1174814446
Name:TOTAL HEALTH CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:603-742-7894
Mailing Address - Street 1:600 STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4370
Mailing Address - Country:US
Mailing Address - Phone:603-742-7894
Mailing Address - Fax:603-766-0523
Practice Address - Street 1:600 STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4370
Practice Address - Country:US
Practice Address - Phone:603-742-7894
Practice Address - Fax:603-766-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7561205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972537470OtherINDIVIDUAL NPI
000042301Medicare PIN