Provider Demographics
NPI:1235211939
Name:CANNATTA, AMY MARIA (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIA
Last Name:CANNATTA
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 1:28756 N 121ST LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3378
Mailing Address - Country:US
Mailing Address - Phone:480-788-9263
Mailing Address - Fax:
Practice Address - Street 1:13927 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2438
Practice Address - Country:US
Practice Address - Phone:480-788-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001662111N00000X
AZ8602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001453Medicare PIN