Healthcare Provider Details

I. General information

NPI: 1649889866
Provider Name (Legal Business Name): EVAN PEAKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 PLAZA DEL SUR DR STE A
SANTA FE NM
87505-6073
US

IV. Provider business mailing address

1892 PLAZA DEL SUR DR STE A
SANTA FE NM
87505-6073
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8017
  • Fax:
Mailing address:
  • Phone: 505-988-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34886
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC2268
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC2268
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: