Provider Demographics
NPI:1487661138
Name:PEARCE, MANDY M (DC)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:M
Last Name:PEARCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:M
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1001 CECELIA DR
Mailing Address - Street 2:PEWAUKEE FAMILY CHIROPRACTIC
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2546
Mailing Address - Country:US
Mailing Address - Phone:262-695-9206
Mailing Address - Fax:262-695-9302
Practice Address - Street 1:1001 CECELIA DR
Practice Address - Street 2:PEWAUKEE FAMILY CHIROPRACTIC
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2546
Practice Address - Country:US
Practice Address - Phone:262-695-9206
Practice Address - Fax:262-695-9302
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4175012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487661138Medicaid