Provider Demographics
NPI:1689672008
Name:PEABODY, COLETTE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:MARIE
Last Name:PEABODY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 WESTLOOP PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2840
Mailing Address - Country:US
Mailing Address - Phone:913-980-7675
Mailing Address - Fax:785-320-5258
Practice Address - Street 1:600 CAISSON HILL
Practice Address - Street 2:IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FT. RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442
Practice Address - Country:US
Practice Address - Phone:785-239-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS04622111N00000X
KS04622111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47730Medicare UPIN
572A388Medicare ID - Type Unspecified