Provider Demographics
NPI:1639234529
Name:PIERCE, DAVID GORDON (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GORDON
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DC
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 971
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-0971
Mailing Address - Country:US
Mailing Address - Phone:801-763-8662
Mailing Address - Fax:801-763-8664
Practice Address - Street 1:5337 W 11000 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9403
Practice Address - Country:US
Practice Address - Phone:801-763-8662
Practice Address - Fax:801-763-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT931759851201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056085Medicare ID - Type Unspecified
UTT92268Medicare UPIN