Provider Demographics
NPI:1982862264
Name:PEARSON, JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PEARSON
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 1:5910 I-20 WEST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-3585
Mailing Address - Country:US
Mailing Address - Phone:817-274-0222
Mailing Address - Fax:817-274-0922
Practice Address - Street 1:5910 I-20 WEST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3585
Practice Address - Country:US
Practice Address - Phone:817-274-0222
Practice Address - Fax:817-274-0922
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 5285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001751901Medicaid
TX604501OtherBLUE CROSS BLUE SHIELD