Healthcare Provider Details

I. General information

NPI: 1609207968
Provider Name (Legal Business Name): ACCIDENT SPINE & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GADSDEN HWY
BIRMINGHAM AL
35235-1006
US

IV. Provider business mailing address

819 MIMOSA PARK RD
TUSCALOOSA AL
35405-4839
US

V. Phone/Fax

Practice location:
  • Phone: 205-561-6005
  • Fax: 205-201-5004
Mailing address:
  • Phone: 205-752-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1932
License Number StateAL

VIII. Authorized Official

Name: DR. BRENT ALAN TIDWELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 256-383-5772