Provider Demographics
NPI:1588704597
Name:BARTSCHER, KEENAN (LAC)
Entity type:Individual
Prefix:MR
First Name:KEENAN
Middle Name:
Last Name:BARTSCHER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 NE 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6529
Mailing Address - Country:US
Mailing Address - Phone:503-522-2872
Mailing Address - Fax:503-243-7616
Practice Address - Street 1:917 SW OAK ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2806
Practice Address - Country:US
Practice Address - Phone:503-522-2872
Practice Address - Fax:503-243-7616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00672171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist