Provider Demographics
NPI:1063440261
Name:PEASLEE, RICHARD VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VINCENT
Last Name:PEASLEE
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 1:118 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-0051
Mailing Address - Country:US
Mailing Address - Phone:763-444-9737
Mailing Address - Fax:763-444-6540
Practice Address - Street 1:118 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-0051
Practice Address - Country:US
Practice Address - Phone:763-444-9737
Practice Address - Fax:763-444-6540
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN214E3PEOtherMINNESOTA BC/BS
MN09N35ISOtherMINNESOTA BC/BS
MN09N35ISOtherMINNESOTA BC/BS