Provider Demographics
NPI:1275599698
Name:WELCH, BRODIE (LAC)
Entity Type:Individual
Prefix:MS
First Name:BRODIE
Middle Name:
Last Name:WELCH
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 1:534 NW 4TH ST
Mailing Address - Street 2:LIFE IN BALANCE ACUPUNCTURE
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:LIFE IN BALANCE ACUPUNCTURE
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist