Provider Demographics
NPI:1871007468
Name:ALIVE REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:ALIVE REHABILITATION SERVICES LLC
Other - Org Name:ALIVE CHIROPRACTIC & REHABILITATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:971-344-4208
Mailing Address - Street 1:1706 AVALON DR UNIT 20
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9585
Mailing Address - Country:US
Mailing Address - Phone:971-344-4208
Mailing Address - Fax:
Practice Address - Street 1:102 E 2ND ST UNIT 3
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1733
Practice Address - Country:US
Practice Address - Phone:971-344-4208
Practice Address - Fax:971-344-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty