Provider Demographics
NPI:1104968759
Name:PECSOK, J A (DC)
Entity type:Individual
Prefix:DR
First Name:J
Middle Name:A
Last Name:PECSOK
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 1:26493 HOOVER PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48090-1228
Mailing Address - Country:US
Mailing Address - Phone:586-757-6200
Mailing Address - Fax:586-757-8605
Practice Address - Street 1:26493 HOOVER
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48090-1228
Practice Address - Country:US
Practice Address - Phone:586-757-6200
Practice Address - Fax:586-757-8605
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJP002473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E03864OtherBLUE CROSS
MI950E05148OtherBCBS MI
MI950E05148OtherBCBS MI
MI0E05148Medicare PIN