Provider Demographics
NPI:1205950227
Name:SPECK, DOUGLAS P (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:SPECK
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 1:405 E SANGAMON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1762
Mailing Address - Country:US
Mailing Address - Phone:217-522-5300
Mailing Address - Fax:
Practice Address - Street 1:405 E SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1762
Practice Address - Country:US
Practice Address - Phone:217-522-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL995460Medicare PIN