Provider Demographics
NPI:1578884599
Name:PIERCE, TARA (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LAC
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
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31538111N00000X
CA14993171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist