Provider Demographics
NPI:1730394735
Name:CANCEL, DOUGLAS FRANCIS JR (DC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANCIS
Last Name:CANCEL
Suffix:JR
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:PO BOX 3915
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-0819
Mailing Address - Country:US
Mailing Address - Phone:925-945-1155
Mailing Address - Fax:925-945-1440
Practice Address - Street 1:2099 MT DIABLO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8495
Practice Address - Country:US
Practice Address - Phone:925-945-1155
Practice Address - Fax:925-945-1440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC151570Medicare ID - Type Unspecified