Healthcare Provider Details

I. General information

NPI: 1285739052
Provider Name (Legal Business Name): JOSEPH CHARLES FIORINO JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E WALNUT ST TOWN AND COUNTRY PLAZA
THAYER MO
65791-1516
US

IV. Provider business mailing address

139 E WALNUT ST TOWN AND COUNTRY PLAZA
THAYER MO
65791-1516
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-7610
  • Fax: 417-264-7619
Mailing address:
  • Phone: 417-264-7610
  • Fax: 417-264-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2006011828
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: