Provider Demographics
NPI:1184638066
Name:PIERSOL, GREGORY L (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:PIERSOL
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-0368
Mailing Address - Country:US
Mailing Address - Phone:740-992-1000
Mailing Address - Fax:740-992-1005
Practice Address - Street 1:236 E MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-1022
Practice Address - Country:US
Practice Address - Phone:740-992-1000
Practice Address - Fax:740-992-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02078308400OtherOH WORKERS COMP
OH2510170Medicaid
W03526AOtherHEALTH PLAN
WV3810000570OtherUNISYS
PI4134262Medicare ID - Type Unspecified
WV3810000570OtherUNISYS
V00020Medicare UPIN