Healthcare Provider Details

I. General information

NPI: 1194082180
Provider Name (Legal Business Name): MARTY CLYDE LOVVORN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 OWENS PKWY SUITE A
BIRMINGHAM AL
35244-1657
US

IV. Provider business mailing address

102 BOWLING LN
PELHAM AL
35124-4353
US

V. Phone/Fax

Practice location:
  • Phone: 205-988-9848
  • Fax:
Mailing address:
  • Phone: 205-988-9848
  • Fax: 205-998-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2366
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: