Healthcare Provider Details

I. General information

NPI: 1861759110
Provider Name (Legal Business Name): ACCIDENT SPINE AND REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BEAR CREEK CUTOFF RD OFC ROAD
TUSCALOOSA AL
35405-5964
US

IV. Provider business mailing address

819 MIMOSA PARK RD SUITE D
TUSCALOOSA AL
35405-4839
US

V. Phone/Fax

Practice location:
  • Phone: 205-561-6000
  • Fax: 205-759-2709
Mailing address:
  • Phone: 205-561-2195
  • Fax: 205-752-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2100
License Number StateAL

VIII. Authorized Official

Name: DR. BRENT A TIDWELL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 205-561-2195