MEDICARE: COMMUNITY ALTERNATIVE MEDICINE

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	261QH0100X	Health Service Clinic/Center	AC00956	OR

General Provider Information

NPI Number	:	1790058758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ALTERNATIVE MEDICINE

Provider Business Mailing Address
First Line	:	PO BOX 632
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-0038
Country	:	US
Telephone Number	:	503-656-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 MADISON ST
Second Line	:	SUITE 106
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2354
Country	:	US
Telephone Number	:	503-656-3110
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	MS. ROBIN MARCINKIEWICZ
Credential	:	L. AC.
Telephone Number	:	503-656-3110

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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