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General NPI Number Information
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NPI Number | 1649641101
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Entity Type | Organization
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Legal Business Name | PELOCK CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 2240 PRAIRIE AVE SUITE 5
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City | BELOIT
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State | WI
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Zip | 53511-2648
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Country | US
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Telephone | 608-290-2366
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 PRAIRIE AVE SUITE 5
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City | BELOIT
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State | WI
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Zip | 53511-2648
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Country | US
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Telephone | 608-312-2586
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SETH PELOCK
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Credential | D.C.
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Telephone | 608-290-2366
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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 | 5109-12
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License Number State | WI
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