Brent  A  Tidwell    DC
Contract Details
ChiroPlus of Alabama
Facility name
Provider ID
P000001746
NPI
1154438802
Tax ID
721380894
Effective Date
3/8/2002
Last Updated
10/6/2014
Direct Contract
Yes
Term Date
10/6/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
819 Mimosa Park Road
Tuscaloosa, AL 35405
United States
County
Tuscaloosa
Phone
2057527503 (Phone)
Billing Details
Address
819 Mimosa Park Road
Tuscaloosa, AL 35405
Billing Phone
2057527503
Specialty Type
Chiropractic Medicine
Map
Address