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General NPI Number Information
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NPI Number | 1457531469
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Entity Type | Individual
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Provider Name | PRESTON PHILLIP PEACHEE II D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 460 ASHLEY RIDGE BLVD SUITE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-7228
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Country | US
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Telephone | 318-865-2225
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Fax | 318-865-2410
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Provider Business Mailing Address
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Address Line | 460 ASHLEY RIDGE BLVD SUITE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106-7228
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Country | US
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Telephone | 318-865-2225
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Fax | 318-865-2410
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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 | 1422
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License Number State | LA
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