Provider Demographics
NPI:1538309042
Name:PEACOCK, BRENDA LYNN (M AC, L AC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LYNN
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:M AC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-7000
Mailing Address - Country:US
Mailing Address - Phone:970-692-0202
Mailing Address - Fax:970-532-2976
Practice Address - Street 1:2024 BRECKENRIDGE DR
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-7000
Practice Address - Country:US
Practice Address - Phone:970-692-0202
Practice Address - Fax:970-532-2976
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist