Provider Demographics
NPI:1255543500
Name:PEARCE, MITCHELL JAMESON (DC, MS, LAC)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAMESON
Last Name:PEARCE
Suffix:
Gender:M
Credentials:DC, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 WILLIAMSPORT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-3327
Mailing Address - Country:US
Mailing Address - Phone:408-293-3883
Mailing Address - Fax:866-439-6028
Practice Address - Street 1:1591 WILLIAMSPORT DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3327
Practice Address - Country:US
Practice Address - Phone:408-293-3883
Practice Address - Fax:866-439-6028
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 14535111NN1001X, 111NS0005X
MA657111NN1001X, 111NS0005X
CAAC 4378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4378OtherCALIFORNIA ACUPUNCTURE BOARD
MA657OtherBOARD OF REGISTRATION OF CHIROPRACTORS
CADC14535OtherCALIFORNIA BOARD OF CHIROPRACTIC EXAMINERS