Provider Demographics
NPI:1346560513
Name:JAMES C PIERCE DC PC
Entity Type:Organization
Organization Name:JAMES C PIERCE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-325-2315
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0244
Mailing Address - Country:US
Mailing Address - Phone:631-325-2315
Mailing Address - Fax:631-325-2316
Practice Address - Street 1:295 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0244
Practice Address - Country:US
Practice Address - Phone:631-325-2315
Practice Address - Fax:631-325-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006454-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX48411Medicare UPIN