Healthcare Provider Details

I. General information

NPI: 1629589718
Provider Name (Legal Business Name): LA VIE CHIROPRACTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 MONTCLAIR RD
BIRMINGHAM AL
35213-1204
US

IV. Provider business mailing address

972 MONTCLAIR RD
BIRMINGHAM AL
35213-1204
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-5445
  • Fax: 205-957-5501
Mailing address:
  • Phone: 205-957-5445
  • Fax: 205-957-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2053
License Number StateAL

VIII. Authorized Official

Name: DR. TAJUAN WOODY
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 205-957-5445