MEDICARE: DR. ANNETTE N CANNON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5409	MN

General Provider Information

NPI Number	:	1073812533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE N CANNON D.C.

Provider Business Mailing Address
First Line	:	3801 W 50TH ST
Second Line	:	SUITE 250-B
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2047
Country	:	US
Telephone Number	:	612-787-2173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 W 50TH ST
Second Line	:	SUITE 250-B
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2047
Country	:	US
Telephone Number	:	612-787-2173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	08/20/2013

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