Provider Demographics
NPI:1922014075
Name:PECK, JEFFREY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
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:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970
Mailing Address - Country:US
Mailing Address - Phone:239-369-9109
Mailing Address - Fax:239-369-4762
Practice Address - Street 1:3020 LEE BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-2438
Practice Address - Country:US
Practice Address - Phone:239-369-9109
Practice Address - Fax:239-369-4762
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380583200Medicaid
FL55139Medicare ID - Type UnspecifiedMEDICARE #
FLU49142Medicare UPIN