Provider Demographics
NPI:1598899080
Name:MARK PIERCE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MARK PIERCE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-645-0777
Mailing Address - Street 1:12620 BEACH BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7130
Mailing Address - Country:US
Mailing Address - Phone:904-645-0777
Mailing Address - Fax:904-645-3483
Practice Address - Street 1:12620 BEACH BLVD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7130
Practice Address - Country:US
Practice Address - Phone:904-645-0777
Practice Address - Fax:904-645-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55291OtherBLUE CROSS PROVIDER NUMBE
FL55291OtherBLUE CROSS PROVIDER NUMBE