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General NPI Number Information
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NPI Number | 1649691858
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Entity Type | Organization
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Legal Business Name | ACCIDENT SPINE & REHAB
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 1401 3RD AVE W SUITE 108
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City | BIRMINGHAM
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State | AL
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Zip | 35208-5300
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Country | US
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Telephone | 205-561-6015
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Fax | 205-957-6740
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Provider Business Mailing Address
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Address Line | 819 MIMOSA PARK RD
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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 | 205-561-6015
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT ALAN TIDWELL
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Credential | D.C.
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Telephone | 205-561-6015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2100
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License Number State | AL
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