Provider Demographics
NPI:1275731184
Name:PECK, IVA LIM (LAC,DIPLAC,RN)
Entity Type:Individual
Prefix:MRS
First Name:IVA
Middle Name:LIM
Last Name:PECK
Suffix:
Gender:F
Credentials:LAC,DIPLAC,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6417
Mailing Address - Country:US
Mailing Address - Phone:972-473-9070
Mailing Address - Fax:972-473-9072
Practice Address - Street 1:5924 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6417
Practice Address - Country:US
Practice Address - Phone:972-473-9070
Practice Address - Fax:972-473-9072
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11523520OtherCAQH PROVIDER ID