| Name: | Petrey Chiropractic, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 May 2011 (14 years ago) |
| Entity Number: | 000-013-746 |
| Register Number: | 000013746 |
| ZIP code: | 36695 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 1516 SCHILLINGER RD S.MOBILE, AL 36695 |
| Registered Office Street Address: | 6358 COTTAGE HILL ROADMOBILE, AL 36609 |
Activities
PROVIDE CHIROPRACTIC CARE/REHAB SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679196919 | 2020-05-21 | 2021-03-24 | 1516 SCHILLINGER ROAD SOUTH, MOBILE, AL, 36695, US | 1516 SCHILLINGER ROAD SOUTH, MOBILE, AL, 36695, US | |||||||||||||||||||||
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| Phone | +1 251-635-1224 |
| Fax | 2516350911 |
Authorized person
| Name | DR. WILFRED DARRELL PETREY |
| Role | DOCTOR/OWNER |
| Phone | 2516351224 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102I350926 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| PETREY, DARRELL | Agent | 1516 SCHILLINGER RD S.MOBILE, AL 36695 |
| Name | Role | Address |
|---|---|---|
| PETREY, DARRELL | Member | 1516 SCHILLINGER RD S.MOBILE, AL 36695 |
| Name | Role | Address |
|---|---|---|
| PETREY, DARRELL | Organizer | 1516 SCHILLINGER RD S.MOBILE, AL 36695 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
