Provider Demographics
NPI:1194082180
Name:LOVVORN, MARTY CLYDE (DC)
Entity type:Individual
Prefix:DR
First Name:MARTY
Middle Name:CLYDE
Last Name:LOVVORN
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 1:102 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4353
Mailing Address - Country:US
Mailing Address - Phone:205-988-9848
Mailing Address - Fax:205-998-9897
Practice Address - Street 1:104 OWENS PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1657
Practice Address - Country:US
Practice Address - Phone:205-988-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2366111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation