MEDICARE: MR. KEENAN BARTSCHER L.AC.

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	AC00672	OR

General Provider Information

NPI Number	:	1588704597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEENAN BARTSCHER L.AC.

Provider Business Mailing Address
First Line	:	3305 NE 79TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-6529
Country	:	US
Telephone Number	:	503-522-2872
Fax Number	:	503-243-7616

Provider Business Practice Location Address
First Line	:	917 SW OAK ST.
Second Line	:	SUITE 300
City	:	PORTLAND
State	:	OR
Zip	:	97205-2806
Country	:	US
Telephone Number	:	503-522-2872
Fax Number	:	503-243-7616

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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