Basic Information
Provider Information
NPI: 1164474516
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERSON
FirstName: CHRISTOPHER
MiddleName: JAY
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 41235 260TH ST
Address2:  
City: ETHAN
State: SD
PostalCode: 573347506
CountryCode: US
TelephoneNumber: 6059968435
FaxNumber:  
Practice Location
Address1: 2501 W 22ND ST
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571051305
CountryCode: US
TelephoneNumber: 6053363230
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X995SDY Chiropractic ProvidersChiropractor 

No ID Information.


Home