Provider Demographics
NPI:1609835289
Name:PECK, TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
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 1:14608 WATERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-1606
Mailing Address - Country:US
Mailing Address - Phone:618-977-5419
Mailing Address - Fax:256-253-5502
Practice Address - Street 1:2934 POINT MALLARD PKWY SE STE B2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5710
Practice Address - Country:US
Practice Address - Phone:256-584-9554
Practice Address - Fax:256-253-5502
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6062111N00000X
IL038007895111N00000X
AL1488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105091OtherBCBS MISSOURI
IL06007868OtherBCBS ILLINOIS
30447OtherGHP
4400120OtherUHC
371384821OtherTRICARE
U39962OtherMERCY
AL1891268439OtherBC ALABAMA
371384821OtherTRICARE
IL038007895Medicaid
U39962Medicare UPIN
350047655Medicare ID - Type UnspecifiedRAILROAD MEDICARE