Provider Demographics
NPI:1598763278
Name:CANNON, JAYSON D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:D
Last Name:CANNON
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004
Mailing Address - Country:US
Mailing Address - Phone:901-840-2234
Mailing Address - Fax:901-840-2237
Practice Address - Street 1:76 TABB DR
Practice Address - Street 2:SUITE C
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-8611
Practice Address - Country:US
Practice Address - Phone:901-840-2234
Practice Address - Fax:901-840-2237
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001905111N00000X
TNDC00000001905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4166378OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN1770755134Medicare UPIN
TN3672589Medicare PIN