Provider Demographics
NPI:1356618060
Name:REBECCA J. CANNON, D.C,P.C
Entity type:Organization
Organization Name:REBECCA J. CANNON, D.C,P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DC,P,C
Authorized Official - Phone:541-567-0944
Mailing Address - Street 1:405 N 1ST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1843
Mailing Address - Country:US
Mailing Address - Phone:541-567-0944
Mailing Address - Fax:541-567-7266
Practice Address - Street 1:405 N 1ST ST STE 110
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1843
Practice Address - Country:US
Practice Address - Phone:541-567-0944
Practice Address - Fax:541-567-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty