Provider Demographics
NPI:1326061219
Name:PECK, TERESA G (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:G
Last Name:PECK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-343-2117
Mailing Address - Fax:309-343-6639
Practice Address - Street 1:777 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-343-2117
Practice Address - Fax:309-343-6639
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350039076OtherRAILROAD MEDICARE
0008182018OtherBCBS
IL038003972Medicaid
IL915130Medicare PIN
IL350039076OtherRAILROAD MEDICARE