Healthcare Provider Details

I. General information

NPI: 1306707229
Provider Name (Legal Business Name): COMPLETE VITALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21040 MIFLIN ROAD STE 6
FOLEY AL
36535-9297
US

IV. Provider business mailing address

819 MIMOSA PARK ROAD STE D
TUSCALOOSA AL
35405-4839
US

V. Phone/Fax

Practice location:
  • Phone: 205-561-6010
  • Fax: 855-975-3042
Mailing address:
  • Phone: 205-561-6010
  • Fax: 855-975-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENT A. TIDWELL
Title or Position: MANAGING PARTNER
Credential: DC
Phone: 205-752-7503