Healthcare Provider Details

I. General information

NPI: 1215649017
Provider Name (Legal Business Name): RESILIENCE SPINE & SPORTS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 BALCH RD
MADISON AL
35758-9715
US

IV. Provider business mailing address

970 BALCH RD
MADISON AL
35758-9715
US

V. Phone/Fax

Practice location:
  • Phone: 256-258-8255
  • Fax: 205-289-1316
Mailing address:
  • Phone: 256-258-8255
  • Fax: 205-289-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER WILLIAM SARAZEN
Title or Position: OWNER, CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 256-258-8255