Provider Demographics
NPI:1962605006
Name:PEACOCK, GREGORY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
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 1:2902 W STRAFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1031
Mailing Address - Country:US
Mailing Address - Phone:480-231-4702
Mailing Address - Fax:480-831-7770
Practice Address - Street 1:2902 W STRAFORD DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1031
Practice Address - Country:US
Practice Address - Phone:480-231-4702
Practice Address - Fax:480-831-7770
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor