Provider Demographics
NPI:1447308135
Name:REDDEN, VINCENT JEROME (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JEROME
Last Name:REDDEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 GLOVER AVE
Mailing Address - Street 2:COLONY DRIVE, SUITE 27
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2024
Mailing Address - Country:US
Mailing Address - Phone:334-393-4425
Mailing Address - Fax:334-347-7074
Practice Address - Street 1:557 GLOVER AVE
Practice Address - Street 2:COLONY DRIVE, SUITE 27
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2024
Practice Address - Country:US
Practice Address - Phone:334-393-4425
Practice Address - Fax:334-347-7074
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor