Provider Demographics
NPI:1023031895
Name:PIERCE, KENNETH W (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:PIERCE
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 1:28900 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2856
Mailing Address - Country:US
Mailing Address - Phone:951-694-1485
Mailing Address - Fax:951-694-1072
Practice Address - Street 1:28900 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2856
Practice Address - Country:US
Practice Address - Phone:951-694-1485
Practice Address - Fax:951-694-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28996111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition