Provider Demographics
NPI:1366462194
Name:CANN, DALLAS SPENCER (DC)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:SPENCER
Last Name:CANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 E CHANDLER HEIGHTS RD STE 107
Mailing Address - Street 2:CHANDLER HEIGHTS VILLAGE
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4327
Mailing Address - Country:US
Mailing Address - Phone:480-840-3663
Mailing Address - Fax:480-840-3663
Practice Address - Street 1:3076 E CHANDLER HEIGHTS RD STE 107
Practice Address - Street 2:CHANDLER HEIGHTS VILLAGE
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4327
Practice Address - Country:US
Practice Address - Phone:480-840-3663
Practice Address - Fax:480-840-3663
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV01410Medicare UPIN
AZ109193Medicare PIN