Provider Demographics
NPI:1629223953
Name:BISHOP, KENNETH STANLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:STANLEY
Last Name:BISHOP
Suffix:
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 1:344 SW 7TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-265-8680
Mailing Address - Fax:541-265-9595
Practice Address - Street 1:344 SW 7TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-265-8680
Practice Address - Fax:541-265-9595
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR146212OtherMEDICARE PTAN
OR500742922Medicaid