Provider Demographics
NPI:1740248293
Name:PIERSALL, STEVEN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:PIERSALL
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 1:5267 JERSEY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-5215
Mailing Address - Fax:563-355-0107
Practice Address - Street 1:5267 JERSEY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-355-5215
Practice Address - Fax:563-355-0107
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1209734Medicaid
IA47506OtherBCBS
IA1209734Medicaid
IAI6234Medicare ID - Type Unspecified