Provider Demographics
NPI:1790874683
Name:PEYSER, MARC D (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:PEYSER
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 1:1048 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2522
Mailing Address - Country:US
Mailing Address - Phone:203-329-7122
Mailing Address - Fax:203-968-0573
Practice Address - Street 1:1048 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-2522
Practice Address - Country:US
Practice Address - Phone:203-329-7122
Practice Address - Fax:203-968-0573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4217651OtherAETNA
CT05-0000202CT01OtherANTHEM
CT202000OtherCONNECTICARE
CT4004016Medicaid
CTT 23480Medicare UPIN