Healthcare Provider Details

I. General information

NPI: 1750333860
Provider Name (Legal Business Name): CANTON CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S TRADE DAYS BLVD
CANTON TX
75103-3302
US

IV. Provider business mailing address

PO BOX 226656
DALLAS TX
75222-6656
US

V. Phone/Fax

Practice location:
  • Phone: 903-567-6106
  • Fax: 906-567-5115
Mailing address:
  • Phone: 903-567-6106
  • Fax: 903-567-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN ZACHARIAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-943-9431