Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | KS04622 | KS |
N | 111NN0400X | Neurology | 04622 | KS |
NPI | 1689672008 |
---|---|
Provider Name | Dr. Colette Marie Peabody |
First Address | Manhattan, KS 66502-2840 |
Second Address | Ft. Riley, KS 66442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 25/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U47730 | (02) |