Provider Demographics
NPI:1689020372
Name:ALIVE INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:ALIVE INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:A. BRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:541-636-3079
Mailing Address - Street 1:1902 JEFFERSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2414
Mailing Address - Country:US
Mailing Address - Phone:541-636-3079
Mailing Address - Fax:541-631-2636
Practice Address - Street 1:1902 JEFFERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2414
Practice Address - Country:US
Practice Address - Phone:541-636-3079
Practice Address - Fax:541-631-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1968175F00000X
OR21683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty