MEDICARE: SOLSTICE NATURAL HEALTH CO.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC01074	OR

General Provider Information

NPI Number	:	1326290198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLSTICE NATURAL HEALTH CO.

Provider Business Mailing Address
First Line	:	9955 SE WASHINGTON ST
Second Line	:	STE 320 #6
City	:	PORTLAND
State	:	OR
Zip	:	97216-2439
Country	:	US
Telephone Number	:	503-253-8818
Fax Number	:	503-253-0377

Provider Business Practice Location Address
First Line	:	9955 SE WASHINGTON ST
Second Line	:	STE 320 #6
City	:	PORTLAND
State	:	OR
Zip	:	97216-2439
Country	:	US
Telephone Number	:	503-253-8818
Fax Number	:	503-253-0377

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERIN KATE FELLENZ BROCKMEYER
Credential	:	LAC.
Telephone Number	:	503-253-8818

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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