Provider Demographics
NPI:1528153772
Name:FIERRO, JUSTIN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:FIERRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5418
Mailing Address - Country:US
Mailing Address - Phone:770-509-3400
Mailing Address - Fax:
Practice Address - Street 1:1205 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 122
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5418
Practice Address - Country:US
Practice Address - Phone:770-509-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGKKMedicare ID - Type Unspecified
GAU85879Medicare UPIN