Provider Demographics
NPI:1891268439
Name:TIMOTHY A PECK DC PC
Entity Type:Organization
Organization Name:TIMOTHY A PECK DC PC
Other - Org Name:YEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-977-5419
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:
Practice Address - Street 1:2934 POINT MALLARD PKWY SE # B2
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5700
Practice Address - Country:US
Practice Address - Phone:256-584-9554
Practice Address - Fax:256-253-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty