Provider Demographics
NPI:1992854806
Name:PIERSON, MICHAEL TODD (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:PIERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:22411 ANTONIO PARKWAY
Mailing Address - Street 2:SUITE C215
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-888-3627
Mailing Address - Fax:949-713-4783
Practice Address - Street 1:22411 ANTONIO PARKWAY
Practice Address - Street 2:SUITE C215
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-888-3627
Practice Address - Fax:949-713-4783
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27149Medicare PIN
CAU95078Medicare UPIN