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General NPI Number Information
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NPI Number | 1649699430
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Entity Type | Organization
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Legal Business Name | RED BRIDGE LLC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 20032 HIGHWAY 11 UNIT 17
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City | WOODSTOCK
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State | AL
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Zip | 35188-3733
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Country | US
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Telephone | 205-936-2144
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Fax | 205-424-9777
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | SHANNON
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State | AL
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Zip | 35142-0293
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Country | US
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Telephone | 205-936-2144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TANYA LYNN SIGVALDSON
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Credential | D.C.
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Telephone | 205-936-2144
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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 | 2054
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License Number State | AL
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