MEDICARE: SAMUEL PIERCEALL L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	0121000862	VA

General Provider Information

NPI Number	:	1023724275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL PIERCEALL L.AC

Provider Business Mailing Address
First Line	:	2904 BYWATER DR APT 114
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-6600
Country	:	US
Telephone Number	:	434-806-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	12097 GAYTON RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-3401
Country	:	US
Telephone Number	:	804-464-7075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	02/28/2023

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