Provider Demographics
NPI:1851315204
Name:PIERSOL, JOHNNY C (DC DABCO)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:PIERSOL
Suffix:
Gender:M
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 445
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714
Mailing Address - Country:US
Mailing Address - Phone:740-423-1012
Mailing Address - Fax:740-423-8579
Practice Address - Street 1:517 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714
Practice Address - Country:US
Practice Address - Phone:740-374-3232
Practice Address - Fax:740-374-6387
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1373111N00000X
WV480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000153105OtherANTHEM
000000153106OtherANTHEM
OH0690757Medicaid
W01373AOtherHEALTH PLAN
000532009OtherMOUNTAIN STATE BCBS
WV0131230000OtherUNISYS
55067803701OtherWV WORKERS COMP
4352349OtherAETNA
OH0690757Medicaid
55067803701OtherWV WORKERS COMP
PT0610182Medicare ID - Type Unspecified