Provider Demographics
NPI:1093866592
Name:PEARSON, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PEARSON
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 1:50 LEANNI WAY UNIT A5
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4753
Mailing Address - Country:US
Mailing Address - Phone:386-246-0739
Mailing Address - Fax:386-246-0737
Practice Address - Street 1:50 LEANNI WAY UNIT A5
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4753
Practice Address - Country:US
Practice Address - Phone:386-246-0739
Practice Address - Fax:386-246-0737
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB086AOtherMEDICARE PTAN