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General NPI Number Information
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NPI Number | 1376542480
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Entity Type | Individual
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Provider Name | ANTHONY W PECK DC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1601 W US HIGHWAY 50
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City | O FALLON
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State | IL
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Zip | 62269-1622
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Country | US
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Telephone | 618-628-8882
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Fax | 618-628-8856
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Provider Business Mailing Address
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Address Line | 1601 W US HIGHWAY 50
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City | O FALLON
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State | IL
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Zip | 62269-1622
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Country | US
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Telephone | 618-628-8882
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Fax | 618-628-8856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-008515
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License Number State | IL
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