Provider Demographics
NPI:1790871838
Name:PIERCE, JUDSON H (DC)
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:H
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 PYRAMID WAY
Mailing Address - Street 2:SUITE #20
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2163
Mailing Address - Country:US
Mailing Address - Phone:775-331-4447
Mailing Address - Fax:775-331-4448
Practice Address - Street 1:2351 PYRAMID WAY
Practice Address - Street 2:SUITE #20
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2163
Practice Address - Country:US
Practice Address - Phone:775-331-4447
Practice Address - Fax:775-331-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVB238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VDC238Medicare PIN