Provider Demographics
NPI:1952489239
Name:BYRNES-PIERCE, TINA M (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:BYRNES-PIERCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 REFSET DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0424
Mailing Address - Country:US
Mailing Address - Phone:608-531-1234
Mailing Address - Fax:608-758-8979
Practice Address - Street 1:1609 REFSET DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0424
Practice Address - Country:US
Practice Address - Phone:608-531-1234
Practice Address - Fax:608-758-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3934-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38955700Medicaid
WI35597Medicare ID - Type Unspecified