Provider Demographics
NPI:1033570460
Name:BRODIE WELCH, L.AC., LLC
Entity Type:Organization
Organization Name:BRODIE WELCH, L.AC., LLC
Other - Org Name:LIFE IN BALANCE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-757-4868
Mailing Address - Street 1:534 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6411
Mailing Address - Country:US
Mailing Address - Phone:541-757-4868
Mailing Address - Fax:
Practice Address - Street 1:534 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6411
Practice Address - Country:US
Practice Address - Phone:541-757-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC-00744261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service