Provider Demographics
NPI:1508253089
Name:PIERCE ACUPUNCTURE CORP
Entity Type:Organization
Organization Name:PIERCE ACUPUNCTURE CORP
Other - Org Name:ADVANCED OC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-300-2028
Mailing Address - Street 1:1501 WESTCLIFF DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5517
Mailing Address - Country:US
Mailing Address - Phone:949-300-2028
Mailing Address - Fax:949-209-4157
Practice Address - Street 1:1501 WESTCLIFF DR
Practice Address - Street 2:SUITE 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5517
Practice Address - Country:US
Practice Address - Phone:949-300-2028
Practice Address - Fax:949-209-4157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty