Healthcare Provider Details

I. General information

NPI: 1306204300
Provider Name (Legal Business Name): THE TREE OF LIFE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SW CROWELL WAY STE 100
BEND OR
97702-1178
US

IV. Provider business mailing address

132 SW CROWELL WAY STE 100
BEND OR
97702-1178
US

V. Phone/Fax

Practice location:
  • Phone: 415-870-6977
  • Fax:
Mailing address:
  • Phone: 415-870-6977
  • Fax: 866-206-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. MELISSA R KEENE
Title or Position: OWNER
Credential: LAC
Phone: 415-870-6977