Provider Demographics
NPI:1588769400
Name:FIORINO CHIROPRACTIC LIFE CENTER
Entity type:Organization
Organization Name:FIORINO CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-264-7610
Mailing Address - Street 1:139 E WALNUT ST
Mailing Address - Street 2:TOWN AND COUNTRY PLAZA
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791-1516
Mailing Address - Country:US
Mailing Address - Phone:417-264-7610
Mailing Address - Fax:417-264-7619
Practice Address - Street 1:139 E WALNUT ST
Practice Address - Street 2:TOWN AND COUNTRY PLAZA
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791-1516
Practice Address - Country:US
Practice Address - Phone:417-264-7610
Practice Address - Fax:417-264-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162623718Medicaid
AR108026718Medicaid
MO752686501Medicaid
MOT42928Medicare UPIN
MO000015022Medicare ID - Type UnspecifiedGROUP MEDICARE #
MOV10297Medicare UPIN
MO259885022Medicare ID - Type UnspecifiedDR. FIORINO, JR. #
AR108026718Medicaid