Provider Demographics
NPI:1326440801
Name:HEALTHCORE WELLNESS, P.A.
Entity Type:Organization
Organization Name:HEALTHCORE WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-646-2673
Mailing Address - Street 1:10475 CENTURION PKWY N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-212-0024
Practice Address - Street 1:10475 CENTURION PKWY N
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5003
Practice Address - Country:US
Practice Address - Phone:904-646-2673
Practice Address - Fax:904-212-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty