Provider Demographics
NPI:1831495894
Name:THE WELLNESS CENTER OF TUSCALOOSA
Entity Type:Organization
Organization Name:THE WELLNESS CENTER OF TUSCALOOSA
Other - Org Name:DR. WAYNE RHODES, CHIROPRACTOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-345-3452
Mailing Address - Street 1:1040 LURLEEN B WALLACE BLVD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2219
Mailing Address - Country:US
Mailing Address - Phone:205-345-3452
Mailing Address - Fax:
Practice Address - Street 1:1040 LURLEEN B WALLACE BLVD S
Practice Address - Street 2:SUITE A
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2219
Practice Address - Country:US
Practice Address - Phone:205-345-3452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104982008OtherPREVIOUS NPI AS SOLE PROVIDER
71047OtherBC/BS AL PROVIDER
000071047OtherMEDICARE PTAN
T68553OtherUPIN
000071047OtherMEDICARE PTAN