Provider Demographics
NPI:1457531469
Name:PEACHEE, PRESTON PHILLIP II (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:PHILLIP
Last Name:PEACHEE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:460 ASHLEY RIDGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7228
Mailing Address - Country:US
Mailing Address - Phone:318-865-2225
Mailing Address - Fax:318-865-2410
Practice Address - Street 1:460 ASHLEY RIDGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7228
Practice Address - Country:US
Practice Address - Phone:318-865-2225
Practice Address - Fax:318-865-2410
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor