Provider Demographics
NPI:1003160250
Name:BIRMINGHAM WELLNESS LLC
Entity type:Organization
Organization Name:BIRMINGHAM WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-313-3562
Mailing Address - Street 1:5426 HIGHWAY 280
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6599
Mailing Address - Country:US
Mailing Address - Phone:205-981-8090
Mailing Address - Fax:877-516-0838
Practice Address - Street 1:5426 HIGHWAY 280
Practice Address - Street 2:SUITE 7
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6599
Practice Address - Country:US
Practice Address - Phone:205-981-8090
Practice Address - Fax:877-516-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2015-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty