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General NPI Number Information
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NPI Number | 1861759110
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Entity Type | Organization
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Legal Business Name | ACCIDENT SPINE AND REHAB INC
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 345 BEAR CREEK CUTOFF RD OFC 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 | 205-561-6000
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Fax | 205-759-2709
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Provider Business Mailing Address
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Address Line | 819 MIMOSA PARK RD SUITE 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 | 205-561-2195
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Fax | 205-752-7513
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT A TIDWELL
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Credential | D.C.
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Telephone | 205-561-2195
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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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