Provider Demographics
NPI:1497070627
Name:ATHLETIC PERFORMANCE ENRICHMENT SPECIALISTS LLC
Entity Type:Organization
Organization Name:ATHLETIC PERFORMANCE ENRICHMENT SPECIALISTS LLC
Other - Org Name:THE APE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-414-7895
Mailing Address - Street 1:1651 INDEPENDENCE CT
Mailing Address - Street 2:121
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4153
Mailing Address - Country:US
Mailing Address - Phone:205-414-7895
Mailing Address - Fax:205-414-7896
Practice Address - Street 1:1651 INDEPENDENCE CT
Practice Address - Street 2:121
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4153
Practice Address - Country:US
Practice Address - Phone:205-414-7895
Practice Address - Fax:205-414-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2303111N00000X
AL297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty