Provider Demographics
NPI:1790174456
Name:PEACOCK, MATTHEW JOEL (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOEL
Last Name:PEACOCK
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 1:408 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1309
Mailing Address - Country:US
Mailing Address - Phone:989-734-3384
Mailing Address - Fax:
Practice Address - Street 1:4266 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-4035
Practice Address - Country:US
Practice Address - Phone:989-792-6702
Practice Address - Fax:989-729-1128
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor