Organization
FULL LIFE REGENERATION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER MELSON DO (OWNER)
(256) 765-0002
Entity
Organization
Contact information
Practice address
117 RENAISSANCE ST, FLORENCE, AL 35630-1207
(256) 765-0002
(256) 765-0022
Mailing address
117 RENAISSANCE ST, FLORENCE, AL 35630-1207
(256) 765-0002
(256) 765-0022
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207Q00000X
Family Medicine Physician
—
—
225100000X
Physical Therapist
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1769
LICENSE
AL
Enumeration date
01/07/2021
Last updated
05/26/2021
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