Provider Demographics
NPI:1700247467
Name:PECK'S FAMILY ACUPUNCTURE
Entity Type:Organization
Organization Name:PECK'S FAMILY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DORETTE
Authorized Official - Last Name:PECK-LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:207-206-2361
Mailing Address - Street 1:31 LOG CABIN LN
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-3610
Mailing Address - Country:US
Mailing Address - Phone:207-206-2361
Mailing Address - Fax:207-247-1417
Practice Address - Street 1:813 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3006
Practice Address - Country:US
Practice Address - Phone:207-247-7388
Practice Address - Fax:207-247-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty