Provider Demographics
NPI:1376909051
Name:PIERCE, LANDRA JO (DC)
Entity Type:Individual
Prefix:MRS
First Name:LANDRA
Middle Name:JO
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LANDRA
Other - Middle Name:JO
Other - Last Name:LAPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1024 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9120
Mailing Address - Country:US
Mailing Address - Phone:605-882-3726
Mailing Address - Fax:
Practice Address - Street 1:842 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5788
Practice Address - Country:US
Practice Address - Phone:920-574-3622
Practice Address - Fax:920-574-3661
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor