Healthcare Provider Details

I. General information

NPI: 1609835289
Provider Name (Legal Business Name): TIMOTHY PECK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 POINT MALLARD PKWY SE STE B2
DECATUR AL
35603-5710
US

IV. Provider business mailing address

14608 WATERVIEW LN
ATHENS AL
35613-1606
US

V. Phone/Fax

Practice location:
  • Phone: 256-584-9554
  • Fax: 256-253-5502
Mailing address:
  • Phone: 618-977-5419
  • Fax: 256-253-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6062
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007895
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1488
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: