Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2366 | AL |
NPI | 1194082180 |
---|---|
Provider Name | Dr. Marty Clyde Lovvorn |
First Address | Pelham, AL 35124-4353 |
Second Address | Birmingham, AL 35244-1657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2012 |
Last Update Date | 17/05/2019 |