Provider Demographics
NPI:1225195704
Name:PEPPARD, DEAN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
Last Name:PEPPARD
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 1:10953 MERIDIAN DR
Mailing Address - Street 2:SUITE O
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90633-5143
Mailing Address - Country:US
Mailing Address - Phone:714-821-4265
Mailing Address - Fax:714-821-9730
Practice Address - Street 1:10953 MERIDIAN DR
Practice Address - Street 2:SUITE O
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90633-5143
Practice Address - Country:US
Practice Address - Phone:714-821-4265
Practice Address - Fax:714-821-9730
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20740Medicare ID - Type Unspecified
U09966Medicare UPIN