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General NPI Number Information
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NPI Number | 1508722182
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Entity Type | Organization
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Legal Business Name | COMPLETE VITALITY LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 345 BEAR CREEK CUTOFF ROAD
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City | TUSCALOOSA
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State | AL
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Zip | 35405-5964
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Country | US
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Telephone | 205-561-6010
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Fax | 855-975-3042
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Provider Business Mailing Address
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Address Line | 819 MIMOSA PARK ROAD STE D
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City | TUSCALOOSA
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State | AL
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Zip | 35405-4839
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Country | US
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Telephone | 205-561-6010
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Fax | 855-975-3042
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. BRENT A. TIDWELL
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Credential | DC
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Telephone | 205-752-7503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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