MEDICARE: CHRISTOPHER PIERCE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227012187	IL

General Provider Information

NPI Number	:	1255895884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PIERCE LMT

Provider Business Mailing Address
First Line	:	5827 N WINTHROP AVE # 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3511
Country	:	US
Telephone Number	:	773-998-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	5827 N WINTHROP AVE # 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3511
Country	:	US
Telephone Number	:	773-998-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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