Provider Demographics
NPI:1407855042
Name:PIERSON, VICTOR LEE (DC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:LEE
Last Name:PIERSON
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 1:1936 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1450
Mailing Address - Country:US
Mailing Address - Phone:717-261-1499
Mailing Address - Fax:717-261-1350
Practice Address - Street 1:1936 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1450
Practice Address - Country:US
Practice Address - Phone:717-261-1499
Practice Address - Fax:717-261-1350
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005122L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA734174Medicare ID - Type Unspecified
PAU531138Medicare UPIN