Healthcare Provider Details

I. General information

NPI: 1164485256
Provider Name (Legal Business Name): CHRISTINE CANNON DIPL.OM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 HAWK PKWY UNIT 216B
MONTROSE CO
81401-6472
US

IV. Provider business mailing address

1404 HAWK PKWY UNIT 216B
MONTROSE CO
81401-6472
US

V. Phone/Fax

Practice location:
  • Phone: 970-648-4429
  • Fax:
Mailing address:
  • Phone: 970-648-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number993
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number228
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: