Provider Demographics
NPI:1619513538
Name:HABENICHT, PEYTON ALEXANDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:ALEXANDRA
Last Name:HABENICHT
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 1:1820 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1535
Mailing Address - Country:US
Mailing Address - Phone:331-801-0592
Mailing Address - Fax:
Practice Address - Street 1:1025 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2550
Practice Address - Country:US
Practice Address - Phone:847-984-2702
Practice Address - Fax:847-984-2786
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor