Healthcare Provider Details

I. General information

NPI: 1639042153
Provider Name (Legal Business Name): SKYLINE INTEGRATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S HAMILTON ST STE 101
PORTLAND OR
97239-4784
US

IV. Provider business mailing address

224 S HAMILTON ST STE 101
PORTLAND OR
97239-4784
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-5005
  • Fax: 503-222-1039
Mailing address:
  • Phone: 503-222-5005
  • Fax: 503-222-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ANN FLETCHER
Title or Position: CEO
Credential: DC, LAC
Phone: 541-292-2787