Provider Demographics
NPI:1801961339
Name:KISHBAUGH, RENEE (DC)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:KISHBAUGH
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 1:8600 E ROCKCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9733
Mailing Address - Country:US
Mailing Address - Phone:520-247-5549
Mailing Address - Fax:
Practice Address - Street 1:4511 N CAMPBELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6424
Practice Address - Country:US
Practice Address - Phone:520-247-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU94441Medicare UPIN
AZ73370Medicare ID - Type Unspecified