Healthcare Provider Details

I. General information

NPI: 1346639747
Provider Name (Legal Business Name): PIERCE CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WESTCLIFF DR SUITE 309
NEWPORT BEACH CA
92660-5517
US

IV. Provider business mailing address

1501 WESTCLIFF DR SUITE 309
NEWPORT BEACH CA
92660-5517
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-2028
  • Fax: 949-209-4157
Mailing address:
  • Phone: 949-300-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31538
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14993
License Number StateCA

VIII. Authorized Official

Name: DR. TARA PIERCE
Title or Position: OWNER
Credential: DC, LAC
Phone: 949-300-2028