1851315204 NPI number — DR. JOHNNY C PIERSOL DC DABCO

Table of content: DR. JOHNNY C PIERSOL DC DABCO (NPI 1851315204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851315204 NPI number — DR. JOHNNY C PIERSOL DC DABCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIERSOL
Provider First Name:
JOHNNY
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC DABCO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851315204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELPRE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-423-1012
Provider Business Mailing Address Fax Number:
740-423-8579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-374-3232
Provider Business Practice Location Address Fax Number:
740-374-6387
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC1373 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 480 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000153105 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000153106 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0690757 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: W01373A . This is a "HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000532009 . This is a "MOUNTAIN STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0131230000 . This is a "UNISYS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 55067803701 . This is a "WV WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4352349 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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