Provider Demographics
NPI:1790906808
Name:PIERCE, THOMAS E (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
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 1:377-379 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2217
Mailing Address - Country:US
Mailing Address - Phone:617-752-4138
Mailing Address - Fax:617-752-4127
Practice Address - Street 1:379 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2217
Practice Address - Country:US
Practice Address - Phone:617-752-4138
Practice Address - Fax:617-752-4127
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40049Medicare UPIN