Healthcare Provider Details

I. General information

NPI: 1497070627
Provider Name (Legal Business Name): ATHLETIC PERFORMANCE ENRICHMENT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 INDEPENDENCE CT 121
BIRMINGHAM AL
35209-4153
US

IV. Provider business mailing address

1651 INDEPENDENCE CT 121
BIRMINGHAM AL
35209-4153
US

V. Phone/Fax

Practice location:
  • Phone: 205-414-7895
  • Fax: 205-414-7896
Mailing address:
  • Phone: 205-414-7895
  • Fax: 205-414-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2303
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number297
License Number StateAL

VIII. Authorized Official

Name: DR. REBECCA WELLS
Title or Position: CO-OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 205-414-7895