Provider Demographics
NPI:1942566575
Name:PETREY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PETREY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINFRED
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:PETREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-661-7577
Mailing Address - Street 1:6356 COTTAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3111
Mailing Address - Country:US
Mailing Address - Phone:251-661-7577
Mailing Address - Fax:
Practice Address - Street 1:6356 COTTAGE HILL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3111
Practice Address - Country:US
Practice Address - Phone:251-661-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty