Provider Demographics
NPI:1205075215
Name:DI FIORE, WILLIAM EDISON JR (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDISON
Last Name:DI FIORE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:EDISON
Other - Last Name:DI FIORE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4770 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1065
Mailing Address - Country:US
Mailing Address - Phone:559-760-4228
Mailing Address - Fax:
Practice Address - Street 1:5612 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5004
Practice Address - Country:US
Practice Address - Phone:559-760-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19759111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health