Provider Demographics
NPI:1174602353
Name:CANCRO, JOANNE (DC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CANCRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STATION AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1222
Mailing Address - Country:US
Mailing Address - Phone:617-244-3330
Mailing Address - Fax:617-244-3309
Practice Address - Street 1:18 STATION AVE
Practice Address - Street 2:UNIT A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1222
Practice Address - Country:US
Practice Address - Phone:617-244-3330
Practice Address - Fax:617-244-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU62538Medicare UPIN
MAY45058Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #