MEDICARE: STILL POINT OSTEOPATHY AND MEDICAL ACUPUNCTURE, LLC

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	DO155807	OR

General Provider Information

NPI Number	:	1891165544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILL POINT OSTEOPATHY AND MEDICAL ACUPUNCTURE, LLC

Provider Business Mailing Address
First Line	:	2955 N HIGHWAY 97 STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 N HIGHWAY 97
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-7559
Country	:	US
Telephone Number	:	541-639-7908
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JESSICA GRECO
Credential	:
Telephone Number	:	541-639-7908

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/09/2015

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