Healthcare Provider Details

I. General information

NPI: 1609870500
Provider Name (Legal Business Name): STEPHEN CANNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 CARL ELLER RD
MARS HILL NC
28754-6000
US

IV. Provider business mailing address

PO BOX 1990
MARS HILL NC
28754-1990
US

V. Phone/Fax

Practice location:
  • Phone: 828-689-3777
  • Fax: 828-689-5435
Mailing address:
  • Phone: 828-689-3777
  • Fax: 828-689-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1419
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: