Provider Demographics
NPI:1811318744
Name:PELOCK, SETH (DC)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:PELOCK
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 1:2240 PRAIRIE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2648
Mailing Address - Country:US
Mailing Address - Phone:608-290-2366
Mailing Address - Fax:
Practice Address - Street 1:2240 PRAIRIE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2648
Practice Address - Country:US
Practice Address - Phone:608-290-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5109-12111N00000X, 111NR0400X
IL038012550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5109-12OtherWISCONSIN