Provider Demographics
NPI:1003965625
Name:FIORE, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:FIORE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8101 SOUTHSIDE BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8067
Mailing Address - Country:US
Mailing Address - Phone:904-646-9355
Mailing Address - Fax:904-646-9708
Practice Address - Street 1:8101 SOUTHSIDE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8067
Practice Address - Country:US
Practice Address - Phone:904-646-9355
Practice Address - Fax:904-646-9708
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4913111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593009162OtherTAX ID
FL593009162OtherTAX ID
FLT94439Medicare UPIN