Provider Demographics
NPI:1437148665
Name:PIERCE, DARRELL FLETCHER (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:FLETCHER
Last Name:PIERCE
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 1:1125 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3902
Mailing Address - Country:US
Mailing Address - Phone:863-293-0040
Mailing Address - Fax:863-294-1419
Practice Address - Street 1:1125 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3902
Practice Address - Country:US
Practice Address - Phone:863-293-0040
Practice Address - Fax:863-294-1419
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00002933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU19282Medicare UPIN
FL8-88490Medicare ID - Type Unspecified