Provider Demographics
NPI:1407826555
Name:PIERCE, DOUGLAS EARL (D C)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EARL
Last Name:PIERCE
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 DAIRY LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8131
Mailing Address - Country:US
Mailing Address - Phone:616-696-6144
Mailing Address - Fax:616-696-6144
Practice Address - Street 1:1394 DAIRY LN NE
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8131
Practice Address - Country:US
Practice Address - Phone:616-696-6144
Practice Address - Fax:616-696-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4447007Medicaid
MIOD95151880OtherBCBSM
MI11285926OtherCAQH
MI4447007Medicaid