MEDICARE: MS. KRISTEN DILLEY LAC

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	171100000X	Acupuncturist	AC 153381	OR

General Provider Information

NPI Number	:	1295031300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN DILLEY LAC

Provider Business Mailing Address
First Line	:	3564 N MISSOURI AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1167
Country	:	US
Telephone Number	:	503-953-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 NE ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-5048
Country	:	US
Telephone Number	:	503-953-0933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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