Provider Demographics
NPI:1164241741
Name:PIERCE, ANDREW JOHN THEODORE (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN THEODORE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 NW BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2281
Mailing Address - Country:US
Mailing Address - Phone:515-494-4954
Mailing Address - Fax:
Practice Address - Street 1:890 SE OLSON DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8641
Practice Address - Country:US
Practice Address - Phone:515-325-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor