Provider Demographics
NPI:1649669961
Name:PEACOCK, CHRISTOPHER (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 117TH ST
Mailing Address - Street 2:APT 4K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4616
Mailing Address - Country:US
Mailing Address - Phone:646-470-3391
Mailing Address - Fax:
Practice Address - Street 1:124 E 117TH ST
Practice Address - Street 2:APT 4K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4616
Practice Address - Country:US
Practice Address - Phone:646-470-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist