Healthcare Provider Details

I. General information

NPI: 1730369216
Provider Name (Legal Business Name): HURST PEACOCK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 E GLENN AVE
AUBURN AL
36830-5014
US

IV. Provider business mailing address

641 E GLENN AVE
AUBURN AL
36830-5014
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD HURST PEACOCK
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 334-501-8867