Provider Demographics
NPI:1720066954
Name:PECK, JOHN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
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 1:2185 CHURN CREEK RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0747
Mailing Address - Country:US
Mailing Address - Phone:530-222-0350
Mailing Address - Fax:530-222-0351
Practice Address - Street 1:2185 CHURN CREEK RD
Practice Address - Street 2:SUITE I
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0747
Practice Address - Country:US
Practice Address - Phone:530-222-0350
Practice Address - Fax:530-222-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0284170111N00000X
CADC28417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0284170OtherBLUE SHIELD
104377600OtherFEDERAL WORK COMP
1042817OtherASAP
1042817OtherCIGNA
1042817OtherUNITED HEALTHCARE
CADC0284170Medicaid
DC0284170OtherBLUE SHIELD