Provider Demographics
NPI:1023724275
Name:PIERCEALL, SAMUEL (LAC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:PIERCEALL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 BYWATER DR APT 114
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6600
Mailing Address - Country:US
Mailing Address - Phone:434-806-2436
Mailing Address - Fax:
Practice Address - Street 1:12097 GAYTON RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-3401
Practice Address - Country:US
Practice Address - Phone:804-464-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000862171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist