Provider Demographics
NPI:1154484665
Name:PEEKS, EDWARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:PEEKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N BOONE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5607
Mailing Address - Country:US
Mailing Address - Phone:423-928-2251
Mailing Address - Fax:423-928-2002
Practice Address - Street 1:401 N BOONE ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5607
Practice Address - Country:US
Practice Address - Phone:423-928-2251
Practice Address - Fax:423-928-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN621013592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14254OtherBCBS OF TENNESSEE
TNH247Medicare ID - Type Unspecified