Provider Demographics
NPI:1861413676
Name:GASTON-PIERCE, TERRI (DC)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:
Last Name:GASTON-PIERCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W CENTRAL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3000
Mailing Address - Country:US
Mailing Address - Phone:714-257-7440
Mailing Address - Fax:714-257-7442
Practice Address - Street 1:385 W CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3000
Practice Address - Country:US
Practice Address - Phone:714-257-7440
Practice Address - Fax:714-257-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18804111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18804Medicare ID - Type Unspecified
CAU16929Medicare UPIN