Provider Demographics
NPI:1306905807
Name:PEACOCK, EDWARD HURST (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HURST
Last Name:PEACOCK
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 1:1685 E UNIVERSITY DR STE E
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5217
Mailing Address - Country:US
Mailing Address - Phone:334-501-8867
Mailing Address - Fax:866-929-4872
Practice Address - Street 1:1685 E UNIVERSITY DR STE E
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-501-8867
Practice Address - Fax:866-929-4872
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51001163OtherBLUE CROSS/BLUE SHEILD
ALK495OtherMEDICARE GROUP
ALK495OtherMEDICARE GROUP
AL051556297Medicare ID - Type Unspecified