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CANNON CHIROPRACTIC

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Company Details

Name: CANNON CHIROPRACTIC
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 13 Nov 2017 (8 years ago)
Entity Number: 598218
Place of Formation: IDAHO
File Number: 0000598218
ZIP code: 83406
County: Bonneville County
Mailing Address: 611 ENSIGN DR AMMON, ID 83406

National Provider Identifier

NPI Number:
1164837647

Authorized Person:

Name:
DR. TIMOTHY W CANNON
Role:
CHIROPRACTIC PHYSICIAN, OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2088744273

Filing

Filing Name Filing Number Filing date
Initial Filing 0000598218 2017-11-13

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State