Provider Demographics
NPI:1730816679
Name:DR CHRISTINE CANNON DAOM LLC DBA MONTROSE ACUPUNCTURE AND HERBAL MEDIC
Entity type:Organization
Organization Name:DR CHRISTINE CANNON DAOM LLC DBA MONTROSE ACUPUNCTURE AND HERBAL MEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, DIPLOM, LAC
Authorized Official - Phone:970-648-4429
Mailing Address - Street 1:1404 HAWK PKWY UNIT 216B
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6472
Mailing Address - Country:US
Mailing Address - Phone:970-648-4429
Mailing Address - Fax:
Practice Address - Street 1:1404 HAWK PKWY UNIT 216B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6472
Practice Address - Country:US
Practice Address - Phone:970-648-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center