MEDICARE: DR. LAURIE L PEARCE D.C.

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	111N00000X	Chiropractor	5583	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	605456	OTHER	TX	BLUR CROSS BLUE SHIELD
2	BLUELINK8261851	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1568460855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE L PEARCE D.C.

Provider Business Mailing Address
First Line	:	123 GILMER RD.
Second Line	:	STE. 3
City	:	LONGVIEW
State	:	TX
Zip	:	75604-4600
Country	:	US
Telephone Number	:	903-295-2422
Fax Number	:	903-757-9390

Provider Business Practice Location Address
First Line	:	123 GILMER RD.
Second Line	:	STE. 3
City	:	LONGVIEW
State	:	TX
Zip	:	75604-4600
Country	:	US
Telephone Number	:	903-295-2422
Fax Number	:	903-757-9390

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	03/25/2009

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