Healthcare Provider Details

I. General information

NPI: 1497933279
Provider Name (Legal Business Name): HEALTHCORE WELLNESS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 1ST ST N SUITE 709
JACKSONVILLE BEACH FL
32250-6944
US

IV. Provider business mailing address

1ST STREET NORTH SUITE 709
JACKSONVILLE BEACH FL
32250-6944
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-2673
  • Fax: 904-278-5554
Mailing address:
  • Phone: 904-270-2673
  • Fax: 904-278-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8750
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN F FIERRO
Title or Position: PRESIDENT/ OWNER
Credential: DC
Phone: 904-270-2673