=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104083468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE CRANE ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 917 SW OAK ST SUITE 300
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97205-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-522-2872
-----------------------------------------------------
Fax | 503-243-7616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 917 SW OAK ST SUITE 300
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97205-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-522-2872
-----------------------------------------------------
Fax | 503-243-7616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KEENAN BARTSCHER
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 503-522-2872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC00672
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------