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General NPI Number Information
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NPI Number | 1700247467
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Entity Type | Organization
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Legal Business Name | PECK'S FAMILY ACUPUNCTURE
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 813 MAIN ST SUITE C
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City | WATERBORO
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State | ME
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Zip | 04087-3006
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Country | US
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Telephone | 207-247-7388
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Fax | 207-247-1417
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Provider Business Mailing Address
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Address Line | 31 LOG CABIN LN
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City | WATERBORO
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State | ME
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Zip | 04087-3610
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Country | US
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Telephone | 207-206-2361
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Fax | 207-247-1417
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JESSICA DORETTE PECK-LINDSEY
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Credential | LAC
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Telephone | 207-206-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC373
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License Number State | ME
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