Provider Demographics
NPI:1558375352
Name:PIERSOL, CHARLES DOUGLAS (DC DACRB)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:PIERSOL
Suffix:
Gender:M
Credentials:DC DACRB
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 965
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-374-3232
Mailing Address - Fax:740-374-6387
Practice Address - Street 1:326 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2994
Practice Address - Country:US
Practice Address - Phone:740-374-3232
Practice Address - Fax:740-374-6387
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1372111NR0400X
OHDC1372111N00000X
WV479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
W01372AOtherHEALTH PLAN
000194827OtherMOUNTAIN STATE BCBS
OH0690766Medicaid
55067803701OtherWV WORKERS COMP
000000153108OtherANTHEM
000000153109OtherANTHEM
WV0131222000OtherUNISYS
OH000000191919OtherUNITED HEALTH CARE MEDICAID
23288676004OtherMEDICAL MUTUAL
4352320OtherAETNA
000194827OtherMOUNTAIN STATE BCBS
000000153108OtherANTHEM
PI0610172Medicare ID - Type Unspecified