Provider Demographics
NPI:1457311268
Name:ANTHONY W PECK, D.C.
Entity Type:Organization
Organization Name:ANTHONY W PECK, D.C.
Other - Org Name:BACK & NECK PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-628-8882
Mailing Address - Street 1:1601 W US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1622
Mailing Address - Country:US
Mailing Address - Phone:618-628-8882
Mailing Address - Fax:618-628-8856
Practice Address - Street 1:1601 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1622
Practice Address - Country:US
Practice Address - Phone:618-628-8882
Practice Address - Fax:618-628-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08225845OtherBLUE CROSS BLUE SHIELD IL
IL573950Medicare PIN
IL08225845OtherBLUE CROSS BLUE SHIELD IL