Provider Demographics
NPI:1487247300
Name:DOERR, PIERCE JULIAN (LMT)
Entity type:Individual
Prefix:
First Name:PIERCE
Middle Name:JULIAN
Last Name:DOERR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 N DAMEN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6106
Mailing Address - Country:US
Mailing Address - Phone:773-517-6011
Mailing Address - Fax:
Practice Address - Street 1:2550 COMPASS RD UNIT A-B
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1610
Practice Address - Country:US
Practice Address - Phone:847-802-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.022022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist