Healthcare Provider Details

I. General information

NPI: 1083995971
Provider Name (Legal Business Name): TAJUAN WOODY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MONTEVALLO RD SUITE B 101
IRONDALE AL
35210-3129
US

IV. Provider business mailing address

4500 MONTEVALLO RD SUITE B 101
IRONDALE AL
35210-3129
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 Code111N00000X
TaxonomyChiropractor
License NumberAL2053
License Number StateAL

VIII. Authorized Official

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