Healthcare Provider Details

I. General information

NPI: 1558375352
Provider Name (Legal Business Name): CHARLES DOUGLAS PIERSOL DC DACRB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 3RD ST
MARIETTA OH
45750-2994
US

IV. Provider business mailing address

PO BOX 965
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-3232
  • Fax: 740-374-6387
Mailing address:
  • Phone: 740-374-3232
  • Fax: 740-374-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1372
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number479
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: