Provider Demographics
NPI:1730324906
Name:YAQUINA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:YAQUINA CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-264-8138
Mailing Address - Street 1:111 SE DOUGLAS ST
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-264-8138
Mailing Address - Fax:541-264-8238
Practice Address - Street 1:111 SE DOUGLAS ST
Practice Address - Street 2:SUITE F-1
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-264-8138
Practice Address - Fax:541-264-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR146211OtherMEDICARE PTAN