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Individual
DR. BRENT ALAN TIDWELL
Active
Individual
DR. BRENT ALAN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1802
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51035545
BLUE CROSS
AL
01
—
51542858
BLUE CROSS
AL
Enumeration date
08/25/2006
Last updated
07/08/2015
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