Healthcare Provider Details

I. General information

NPI: 1689020372
Provider Name (Legal Business Name): ALIVE INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 JEFFERSON ST SUITE 1
EUGENE OR
97405-2414
US

IV. Provider business mailing address

1902 JEFFERSON ST SUITE 1
EUGENE OR
97405-2414
US

V. Phone/Fax

Practice location:
  • Phone: 541-636-3079
  • Fax: 541-631-2636
Mailing address:
  • Phone: 541-636-3079
  • Fax: 541-631-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1968
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21683
License Number StateOR

VIII. Authorized Official

Name: DR. A. BRIELLE MELE
Title or Position: OWNER/PHYSICIAN
Credential: N.D.
Phone: 541-636-3079