Provider Demographics
NPI:1174761415
Name:FISCHLER, KINE (LAC)
Entity type:Individual
Prefix:
First Name:KINE
Middle Name:
Last Name:FISCHLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 NE DUNCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1644
Mailing Address - Country:US
Mailing Address - Phone:415-846-2889
Mailing Address - Fax:
Practice Address - Street 1:1607 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1413
Practice Address - Country:US
Practice Address - Phone:503-281-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1891162640OtherGROUP NUMBER