Provider Demographics
NPI:1992005516
Name:READUS, FONDA LOVEVETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:FONDA
Middle Name:LOVEVETTE
Last Name:READUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 LAKE VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6761
Mailing Address - Country:US
Mailing Address - Phone:601-919-8800
Mailing Address - Fax:601-919-8808
Practice Address - Street 1:1090 LAKE VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6761
Practice Address - Country:US
Practice Address - Phone:601-919-8800
Practice Address - Fax:601-919-8808
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03326555Medicaid