Healthcare Provider Details

I. General information

NPI: 1265700215
Provider Name (Legal Business Name): JUSTIN PEARCE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 BOSTON RD STE 188
LEXINGTON KY
40514-1502
US

IV. Provider business mailing address

3650 BOSTON RD STE 188
LEXINGTON KY
40514-1502
US

V. Phone/Fax

Practice location:
  • Phone: 859-219-0617
  • Fax:
Mailing address:
  • Phone: 925-487-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5298
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: