Provider Demographics
NPI:1184798530
Name:CANNON, NANCY J (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:CANNON
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 1:345 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1621
Mailing Address - Country:US
Mailing Address - Phone:630-766-6200
Mailing Address - Fax:630-496-0315
Practice Address - Street 1:345 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1621
Practice Address - Country:US
Practice Address - Phone:630-766-6200
Practice Address - Fax:630-496-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor