Provider Demographics
NPI:1649699430
Name:RED BRIDGE LLC
Entity type:Organization
Organization Name:RED BRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIGVALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-936-2144
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-0293
Mailing Address - Country:US
Mailing Address - Phone:205-936-2144
Mailing Address - Fax:
Practice Address - Street 1:20032 HIGHWAY 11
Practice Address - Street 2:UNIT 17
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188-3733
Practice Address - Country:US
Practice Address - Phone:205-936-2144
Practice Address - Fax:205-424-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1336249051OtherINDIVIDUAL NPI