Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH 4913 | FL |
NPI | 1003965625 |
---|---|
Provider Name | Dr. Michael Lee Fiore |
First Address | Jacksonville, FL 32256-8067 |
Second Address | Jacksonville, FL 32256-8067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
593009162 | TAX ID (01) | FL |
T94439 | (02) | FL |