Healthcare Provider Details

I. General information

NPI: 1306905807
Provider Name (Legal Business Name): EDWARD HURST PEACOCK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 E UNIVERSITY DR STE E
AUBURN AL
36830
US

IV. Provider business mailing address

1685 E UNIVERSITY DR STE E
AUBURN AL
36830-5217
US

V. Phone/Fax

Practice location:
  • Phone: 334-501-8867
  • Fax: 866-929-4872
Mailing address:
  • Phone: 334-501-8867
  • Fax: 866-929-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2129
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: