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TIMOTHY WADE CANNON D.C.
NPI 1952722290
Chiropractor in Ammon, ID

Active since January 03, 2014
611 ENSIGN DR, AMMON, ID 83406(208) 557-1880 Get Directions Write a Review

NPPES record last updated: February 9, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 9, 2017, Feb 1, 2017, Nov 1, 2016 and 1 more (4 updates tracked since 2016).

About Timothy Wade Cannon D.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIMOTHY WADE CANNON D.C. (NPI 1952722290) is an individual chiropractor in Ammon, Idaho, licensed in Idaho (CHIA-1580) and active in the NPI registry since January 2014. He is a graduate of Western States College Of Chiropractic (2013).

NPPES Registry Identity

NPI1952722290
Entity TypeIndividualMale
Primary Taxonomy111N00000X
Provider Legal NameTIMOTHY WADE CANNONCredential: D.C.
Location Address611 ENSIGN DRAmmon, ID 83406-4777
Mailing Address611 Ensign DrAmmon, ID 83406-4777 · (208) 557-1880
Phone(208) 557-1880
Sole ProprietorYes
Medical School CMSWestern States College Of ChiropracticGraduated 2013
Enumeration DateJanuary 3, 2014
Last NPPES UpdateFebruary 9, 20174 updates tracked since enumeration
✔ NPI 1952722290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License✔ Licensed in ID · CHIA-1580
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
611 ENSIGN DR, Ammon, ID 83406
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Timothy Wade Cannon D.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4385874270
PECOS Enrollment IDI20251125004738

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Timothy Cannon's NPI number?

The NPI number for Timothy Cannon is 1952722290. It was assigned to this individual provider in the NPPES registry on January 3, 2014.

Where is Timothy Cannon located?

Timothy Cannon practices at 611 Ensign Dr, Ammon, ID 83406. The listed phone number is (208) 557-1880.

What is Timothy Cannon's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Timothy Cannon enrolled in Medicare?

Yes. Timothy Cannon is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Timothy Cannon was last updated on February 9, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.