Provider Demographics
NPI:1639498538
Name:TRI-CORE PERFORMANCE INC
Entity type:Organization
Organization Name:TRI-CORE PERFORMANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-687-2124
Mailing Address - Street 1:900 CARILLON PARKWAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716
Mailing Address - Country:US
Mailing Address - Phone:727-687-2124
Mailing Address - Fax:
Practice Address - Street 1:900 CARILLON PARKWAY
Practice Address - Street 2:SUITE 108
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:727-687-2124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-CORE PERFORMANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty