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General NPI Number Information
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NPI Number | 1629369129
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Entity Type | Organization
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Legal Business Name | PIERCE-REYNOLDS CHIROPRACTIC CORP
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 23541 RIDGE ROUTE DR STE C
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1500
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Country | US
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Telephone | 949-954-7577
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Fax | 949-382-1518
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Provider Business Mailing Address
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Address Line | 23541 RIDGE ROUTE DR STE C
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. KEVIN MICHAEL PIERCE
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Credential | DC
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Telephone | 949-954-7577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 31605
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 31321
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 31321
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 31605
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License Number State | CA
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