Healthcare Provider Details

I. General information

NPI: 1003965625
Provider Name (Legal Business Name): MICHAEL LEE FIORE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SOUTHSIDE BLVD SUITE 5
JACKSONVILLE FL
32256-8067
US

IV. Provider business mailing address

8101 SOUTHSIDE BLVD SUITE 5
JACKSONVILLE FL
32256-8067
US

V. Phone/Fax

Practice location:
  • Phone: 904-646-9355
  • Fax: 904-646-9708
Mailing address:
  • Phone: 904-646-9355
  • Fax: 904-646-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH 4913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: