Provider Demographics
NPI:1306977871
Name:PIERCE FAMILY WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:PIERCE FAMILY WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-624-0116
Mailing Address - Street 1:6315 W MARSHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1176
Mailing Address - Country:US
Mailing Address - Phone:704-624-0116
Mailing Address - Fax:704-624-0117
Practice Address - Street 1:6315 W MARSHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1176
Practice Address - Country:US
Practice Address - Phone:704-624-0116
Practice Address - Fax:704-624-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085KRMedicaid
NC2455897-AMedicare ID - Type Unspecified
NCU93636Medicare UPIN