Provider Demographics
NPI:1801965538
Name:STEIN, KENNETH P (DC CCSP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:P
Last Name:STEIN
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301
Mailing Address - Country:US
Mailing Address - Phone:406-234-2964
Mailing Address - Fax:406-234-5341
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301
Practice Address - Country:US
Practice Address - Phone:406-234-2964
Practice Address - Fax:406-234-5341
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000082383Medicare ID - Type UnspecifiedGROUP
T60172Medicare UPIN
000004486Medicare ID - Type Unspecified