Provider Demographics
NPI:1346588902
Name:ADVANCED NEUROPATHY CENTERS OF ALABAMA
Entity Type:Organization
Organization Name:ADVANCED NEUROPATHY CENTERS OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-277-3284
Mailing Address - Street 1:1694 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 132-B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1694
Mailing Address - Country:US
Mailing Address - Phone:205-277-3284
Mailing Address - Fax:
Practice Address - Street 1:1694 MONTGOMERY HWY
Practice Address - Street 2:SUITE 132-B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-1694
Practice Address - Country:US
Practice Address - Phone:205-277-3284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty