Healthcare Provider Details

I. General information

NPI: 1174861611
Provider Name (Legal Business Name): COMPLETE CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 E UNIVERSITY DR STE E
AUBURN AL
36830-5217
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 TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberAL2129
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-092190
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1-092190
License Number StateAL

VIII. Authorized Official

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