Provider Demographics
NPI:1700068731
Name:PETREY, WINFRED DARRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:WINFRED
Middle Name:DARRELL
Last Name:PETREY
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 1:1516 SCHILLINGER RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8933
Mailing Address - Country:US
Mailing Address - Phone:251-635-1224
Mailing Address - Fax:251-635-0911
Practice Address - Street 1:1516 SCHILLINGER RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-8933
Practice Address - Country:US
Practice Address - Phone:251-635-1224
Practice Address - Fax:251-635-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104395111N00000X
AL1648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor