MEDICARE: IAN WILKINSON 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	AC179984	OR

General Provider Information

NPI Number	:	1932642956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN WILKINSON LAC

Provider Business Mailing Address
First Line	:	64718 STARWOOD DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-8426
Country	:	US
Telephone Number	:	541-706-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 NE MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-3491
Country	:	US
Telephone Number	:	541-706-1888
Fax Number	:

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

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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Directions to “ IAN WILKINSON LAC” Practice Location

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