Provider Demographics
NPI:1902868417
Name:CANAL, ALFRED E (DC)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:E
Last Name:CANAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:SINIAWA PLAZA II
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-558-1166
Mailing Address - Fax:570-558-1177
Practice Address - Street 1:711 SCRANTON CARBONDALE HWY
Practice Address - Street 2:SINIAWA PLAZA II
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-558-1166
Practice Address - Fax:570-558-1177
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007896L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2516135OtherAETNA
PA818419OtherFIRST PRIORITY HEALTH
PA3018933OtherCIGNA
PA0018880440003Medicaid
PA3018933OtherCIGNA