Provider Demographics
NPI:1669859682
Name:ALIVE ACUPUNCTURE & WELLNESS CENTER
Entity Type:Organization
Organization Name:ALIVE ACUPUNCTURE & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SODARO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:503-840-0579
Mailing Address - Street 1:8600 SW SALISH LN STE 2
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9632
Mailing Address - Country:US
Mailing Address - Phone:503-840-0579
Mailing Address - Fax:503-570-9000
Practice Address - Street 1:8600 SW SALISH LN STE 2
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9632
Practice Address - Country:US
Practice Address - Phone:503-840-0579
Practice Address - Fax:503-570-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty