Provider Demographics
NPI:1548976566
Name:CANNON CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:CANNON CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZENDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-252-1093
Mailing Address - Street 1:1739 DALE EARNHARDT BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-2102
Mailing Address - Country:US
Mailing Address - Phone:704-938-1141
Mailing Address - Fax:
Practice Address - Street 1:1739 DALE EARNHARDT BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-2102
Practice Address - Country:US
Practice Address - Phone:704-938-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty