Provider Demographics
NPI:1972749604
Name:ALIVE & WELL HEALING ARTS, PC
Entity Type:Organization
Organization Name:ALIVE & WELL HEALING ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAIVATI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARADVAJ
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-484-8647
Mailing Address - Street 1:9900 SW WILSHIRE ST # 190-D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5035
Mailing Address - Country:US
Mailing Address - Phone:503-484-8647
Mailing Address - Fax:503-297-3827
Practice Address - Street 1:9900 SW WILSHIRE ST # 190-D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5035
Practice Address - Country:US
Practice Address - Phone:503-484-8647
Practice Address - Fax:503-297-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1297175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty