Provider Demographics
NPI:1588631675
Name:CANN, KAREN (DC,LPT)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:CANN
Suffix:
Gender:F
Credentials:DC,LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4657 GULF BREEZE PKWY
Mailing Address - Street 2:UNITS A & B
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9166
Mailing Address - Country:US
Mailing Address - Phone:850-916-9304
Mailing Address - Fax:850-916-9306
Practice Address - Street 1:4657 GULF BREEZE PKWY
Practice Address - Street 2:UNITS A & B
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9166
Practice Address - Country:US
Practice Address - Phone:850-916-9304
Practice Address - Fax:850-916-9306
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8649111N00000X
FL20841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3821684Medicaid
FLV08264Medicare UPIN
FL3821684Medicaid
FLQ64013Medicare UPIN