Provider Demographics
NPI:1760438303
Name:PIERCE, WILLIA, RONALD (DCDABCO)
Entity Type:Individual
Prefix:DR
First Name:WILLIA,
Middle Name:RONALD
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DCDABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4801
Mailing Address - Country:US
Mailing Address - Phone:805-922-1721
Mailing Address - Fax:805-928-8582
Practice Address - Street 1:1415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4801
Practice Address - Country:US
Practice Address - Phone:805-922-1721
Practice Address - Fax:805-928-8582
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18073Medicare UPIN