Provider Demographics
NPI:1073230405
Name:FONDREN, WATSON DAVID FLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:WATSON
Middle Name:DAVID FLOYD
Last Name:FONDREN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2811
Mailing Address - Country:US
Mailing Address - Phone:205-861-7297
Mailing Address - Fax:
Practice Address - Street 1:1126 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042-2811
Practice Address - Country:US
Practice Address - Phone:205-928-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2773OtherSTATE OF ALABAMA CHIROPRACTIC LICENSE