Provider Demographics
NPI:1174642151
Name:PIERING, KENNETH ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ARTHUR
Last Name:PIERING
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 1:640 3RD ST N STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-7147
Mailing Address - Country:US
Mailing Address - Phone:904-270-2790
Mailing Address - Fax:904-674-0195
Practice Address - Street 1:640 3RD ST N STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-7147
Practice Address - Country:US
Practice Address - Phone:904-270-2790
Practice Address - Fax:904-674-0195
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1409111N00000X
FLCH11813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor