=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629589718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA VIE CHIROPRACTIQUE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2017
-----------------------------------------------------
Last Update Date | 07/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 972 MONTCLAIR RD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35213-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-957-5445
-----------------------------------------------------
Fax | 205-957-5501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 972 MONTCLAIR RD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35213-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-957-5445
-----------------------------------------------------
Fax | 205-957-5501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. TAJUAN WOODY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 205-957-5445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | 2053
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------