Provider Demographics
NPI:1487842555
Name:PEAK, RONALD D (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:PEAK
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 1:4516 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2210
Mailing Address - Country:US
Mailing Address - Phone:856-778-8653
Mailing Address - Fax:856-596-2832
Practice Address - Street 1:4516 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2210
Practice Address - Country:US
Practice Address - Phone:856-778-8653
Practice Address - Fax:856-596-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00127400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T99393Medicare UPIN
431170Medicare PIN