Provider Demographics
NPI:1417833765
Name:COMPLETE VITALITY
Entity type:Organization
Organization Name:COMPLETE VITALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-752-7503
Mailing Address - Street 1:819 MIMOSA PARK ROAD
Mailing Address - Street 2:STE D
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405
Mailing Address - Country:US
Mailing Address - Phone:205-561-6010
Mailing Address - Fax:855-975-3042
Practice Address - Street 1:201 CELESTE ROAD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571
Practice Address - Country:US
Practice Address - Phone:205-561-6010
Practice Address - Fax:855-975-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty