Provider Demographics
NPI:1477637130
Name:PECK, MICHAEL STEPHAN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHAN
Last Name:PECK
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 1:697 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2814
Mailing Address - Country:US
Mailing Address - Phone:805-658-8600
Mailing Address - Fax:805-643-0534
Practice Address - Street 1:660 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3118
Practice Address - Country:US
Practice Address - Phone:805-658-8600
Practice Address - Fax:805-643-0534
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21866111N00000X
CADC21866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2461836OtherMEDICAL
CA2461836OtherMEDICAL