Provider Demographics
NPI:1366621641
Name:KENNETH A PIERING DC PC
Entity type:Organization
Organization Name:KENNETH A PIERING DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIERING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-353-9676
Mailing Address - Street 1:12401 MIDDLEBROOK RD
Mailing Address - Street 2:#190
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1525
Mailing Address - Country:US
Mailing Address - Phone:301-353-9676
Mailing Address - Fax:
Practice Address - Street 1:12401 MIDDLEBROOK RD
Practice Address - Street 2:#190
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1525
Practice Address - Country:US
Practice Address - Phone:301-353-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1409PT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center