Provider Demographics
NPI:1740352814
Name:BISHOP, KENNETH GARLAND (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GARLAND
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 1:5369 HIGHWAY 90 W STE C
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-4223
Mailing Address - Country:US
Mailing Address - Phone:251-661-0322
Mailing Address - Fax:
Practice Address - Street 1:5369 HIGHWAY 90 W STE C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-4223
Practice Address - Country:US
Practice Address - Phone:251-661-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor