Healthcare Provider Details

I. General information

NPI: 1740016641
Provider Name (Legal Business Name): DR. BENJAMIN DAVID PIERRI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 213TH ST E
GRAHAM WA
98338-8059
US

IV. Provider business mailing address

PO BOX 988
GRAHAM WA
98338-0988
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-2687
  • Fax: 253-846-3012
Mailing address:
  • Phone: 253-847-2687
  • Fax: 253-846-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61595583
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: