| Doctor Name: | KELLY BAUCUM |
| NPI Number: | 1104284736 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAC |
| License Number: | AC175542 |
| Business Practice Address: | 4605 Ne Fremont St Ste 103 Portland, OR - 972131708 |
| Business Phone Number: | 5033955228 |
| Business Fax Number: | |
| Mailing Address: | Po Box 86371, PORTLAND |
| State: | OR |
| Postal Code: | 972860371 |
| Phone Number: | 5033955228 |
| Fax Number: | |
| NPI Enumeration Date: | 02/10/2016 |
| NPI Last Update Date: | 02/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171100000X |
| License Number: | AC175542 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Acupuncturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia. |