Healthcare Provider Details

I. General information

NPI: 1659226314
Provider Name (Legal Business Name): KATHERINE ANDERSON DACM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 NE 4TH ST
BEND OR
97701-4647
US

IV. Provider business mailing address

PO BOX 614
BEND OR
97709-0614
US

V. Phone/Fax

Practice location:
  • Phone: 503-575-8440
  • Fax:
Mailing address:
  • Phone: 503-575-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC226926
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: