Provider Demographics
NPI:1710124771
Name:PIERCE CHIROPRACTIC GROUP INC
Entity Type:Organization
Organization Name:PIERCE CHIROPRACTIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:925-364-2400
Mailing Address - Street 1:2489 DISCOVERY BAY BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-1011
Mailing Address - Country:US
Mailing Address - Phone:925-634-2400
Mailing Address - Fax:925-634-2493
Practice Address - Street 1:2489 DISCOVERY BAY BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-1011
Practice Address - Country:US
Practice Address - Phone:925-634-2400
Practice Address - Fax:925-634-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC028420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty