Provider Demographics
NPI:1407159262
Name:PECHO, GARY A (LAC, MSOM)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:PECHO
Suffix:
Gender:M
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CURTISS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4767
Mailing Address - Country:US
Mailing Address - Phone:630-915-1451
Mailing Address - Fax:
Practice Address - Street 1:1007 CURTISS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4767
Practice Address - Country:US
Practice Address - Phone:630-915-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000921171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist