Provider Demographics
NPI:1477623171
Name:PIERCE, JAMES C (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
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: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:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006454-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX48411Medicare ID - Type UnspecifiedEMPIRE BCBS MEDICARE