Provider Demographics
NPI:1821809229
Name:CINNAMON, KENNETH M
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:CINNAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:M
Other - Last Name:CINNAMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4322
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8322
Mailing Address - Country:US
Mailing Address - Phone:971-718-4567
Mailing Address - Fax:
Practice Address - Street 1:420 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4603
Practice Address - Country:US
Practice Address - Phone:971-718-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist