DR. TIMOTHY PECK (NPI# 1609835289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609835289 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY PECK |
| Credential | DC |
| Practice Address |
#7 Junction Drive Glen Carbon IL 62034 |
| Practice Telephone | 6186929100 |
| Practice Fax Number | 6186921491 |
| Mailing Telephone | 6186929100 |
| Mailing Fax Number | 6186921491 |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2011-11-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 038007895 | IL | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TRICARE | 371384821 | 01 | |
| IL | 038007895 | 05 | |
| UHC | 4400120 | 01 | |
| MERCY | U39962 | 01 | |
| IL | BCBS ILLINOIS | 06007868 | 01 |
| MO | BCBS MISSOURI | 105091 | 01 |
| HEALTHLINK | 254623 | 01 | |
| GHP | 30447 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508151473 | Timothy Charles Peck | Emergency Medicine | 734 Webster St, D, Palo Alto, CA 94301-2630 | 2011-06-17 |
| Street Address |
#7 JUNCTION DRIVE |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689066573 | Christina Tassinari Claywell | Chiropractor | 11 Ginger Creek Vlg, Glen Carbon, IL 62034-3517 | 2015-03-02 |
| 1871984336 | Integrated Medical Group Ltd | Chiropractor | 8 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 2015-02-05 |
| 1669765483 | Andrew C Unfried | Chiropractor | 5 Glen Ed Professional Park, Glen Carbon, IL 62034-3333 | 2011-05-26 |
| 1205142718 | Joshua Hottes | Chiropractor | 11 Junction Dr, Glen Carbon, IL 62034-4300 | 2010-08-20 |
| 1407043714 | Frye Functional Health Center | Chiropractor | 3809 S State Route 159, Glen Carbon, IL 62034-3020 | 2007-10-01 |
| 1386780773 | Brooke Nichole Frye | Chiropractor | 3809 S. State Route 159, Glen Carbon, IL 62034-3020 | 2007-01-30 |
| 1932285483 | Thad S Vuagniaux | Chiropractor | 20 Ginger Creek Pkwy, Glen Carbon, IL 62034-3502 | 2006-10-27 |
| 1770501371 | Wellnessone of Glen Carbon, LLC | Chiropractor | 4517 S State Route 159, Ste 4, Glen Carbon, IL 62034-1584 | 2006-07-18 |
| 1225092885 | Emily Ann Brueggeman | Chiropractor | 108 Magnolia Dr Ste A, Glen Carbon, IL 62034 | 2006-04-12 |
| 1063471993 | Andrew L. Morningstar | Chiropractor | 3733 S State Route 159, Glen Carbon, IL 62034-3043 | 2006-03-20 |
| Find all providers in GLEN CARBON | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
Please comment or provide details below to improve the information on DR. TIMOTHY PECK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.