Provider Demographics
NPI:1609870500
Name:CANNER, STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:CANNER
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 1990
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-1990
Mailing Address - Country:US
Mailing Address - Phone:828-689-3777
Mailing Address - Fax:828-689-5435
Practice Address - Street 1:342 CARL ELLER RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-6000
Practice Address - Country:US
Practice Address - Phone:828-689-3777
Practice Address - Fax:828-689-5435
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908339Medicaid
NC8908339Medicaid
NCT64457Medicare UPIN