Provider Demographics
NPI:1558831701
Name:PEACOCK, SHERI ANN (DC)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:ANN
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WESTRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2425
Mailing Address - Country:US
Mailing Address - Phone:336-617-8113
Mailing Address - Fax:336-617-8190
Practice Address - Street 1:2544 SOMERSET CENTER DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6766
Practice Address - Country:US
Practice Address - Phone:336-617-9890
Practice Address - Fax:336-955-1964
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5044111N00000X
VA0104-557536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor