Provider Demographics
NPI:1457386856
Name:STORY, PEARL DAWN (DC)
Entity type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:DAWN
Last Name:STORY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:PEARL
Other - Middle Name:DAWN
Other - Last Name:WELCHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3131 E 29TH ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-774-0055
Mailing Address - Fax:979-776-0197
Practice Address - Street 1:3131 E 29TH ST
Practice Address - Street 2:BLDG A
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-774-0055
Practice Address - Fax:979-776-0197
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor