Provider Demographics
NPI:1144392366
Name:PEAVY, SAMUEL LAVONE (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LAVONE
Last Name:PEAVY
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 1:1201 ANN ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-3004
Mailing Address - Country:US
Mailing Address - Phone:334-265-7123
Mailing Address - Fax:334-265-6411
Practice Address - Street 1:1201 ANN ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-3004
Practice Address - Country:US
Practice Address - Phone:334-265-7123
Practice Address - Fax:334-265-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51070873OtherBLUE CROSS PROVIDER
AL51070873OtherBLUE CROSS PROVIDER