Provider Demographics
NPI:1568884781
Name:PEEKS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PEEKS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:BRAKE
Authorized Official - Last Name:WOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-928-2251
Mailing Address - Street 1:401 N BOONE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5607
Mailing Address - Country:US
Mailing Address - Phone:423-928-2251
Mailing Address - Fax:423-928-2002
Practice Address - Street 1:401 N BOONE ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5607
Practice Address - Country:US
Practice Address - Phone:423-928-2251
Practice Address - Fax:423-928-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1504300Medicaid
TN0014254OtherBLUE CROSS BLUE SHIELD
TN1504300Medicaid