Lisa Ann Shultz, DSOM, L.AC., LMT

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC208926 Issued in OR

Practice address

1110 SE Alder St Ste 201
Portland, OR 97214-2400

Phone

(503) 477-5051

NPI assigned

Feb 25, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jeremy Jacks Lac LLC

  • Acupuncturist
  • Tigard, OR
  • NPI 1356102347
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1942956222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12860 SW GLENHAVEN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254734",
            "telephone_number": "503-643-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SE ALDER ST STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142400",
            "telephone_number": "503-477-5051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "LISA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DSOM, L.AC., LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-25",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "24554",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC208926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra L. Shulmire, PSY.D.
• David H Shultis, LPC
• Olga Shults, LMT
• William Thomas Shults I, MD
• Daniel Louis Shultz
• Shandra Nicole Shultz, CADC-R, CRM, PSS
• Shawn E Shultz, BSW, CADC I, QMHA
• Douglas A Shumaker, MD
• Andrea Beth Shuman, L.M.T.
• Robin Shuman, RN

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.