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General NPI Number Information
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NPI Number | 1528479417
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Entity Type | Organization
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Legal Business Name | KENKOU
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1726 SYLVAN LN
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City | BILLINGS
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State | MT
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Zip | 59105-3816
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Country | US
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Telephone | 406-969-4213
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 SYLVAN LN
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City | BILLINGS
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State | MT
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Zip | 59105-3816
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Country | US
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Telephone | 406-969-4213
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRIAN BUSHMAN
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Credential | DC
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Telephone | 406-969-4213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHI-CHI-2913
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License Number State | MT
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