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1952722290
TIMOTHY WADE CANNON
AMMON, ID
NPI
1952722290
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
111N00000X Chiropractor
(Licence: ID CHIA-1580)
Enumeration Date
2014-01-03
Last Update Date
2017-02-09
Business Address
-- TIMOTHY WADE CANNON D.C.
611 ENSIGN DR
AMMON, ID 83406-4777
Phone number: 208-557-1880
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Mailing Address
-- TIMOTHY WADE CANNON D.C.
611 ENSIGN DR
AMMON, ID 83406-4777
Phone number: 208-557-1880
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