Provider Demographics
NPI:1083056311
Name:FONKE, JOSEPH B (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:FONKE
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 1:717 GRAVES ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3207
Mailing Address - Country:US
Mailing Address - Phone:336-747-3138
Mailing Address - Fax:
Practice Address - Street 1:717 GRAVES ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3207
Practice Address - Country:US
Practice Address - Phone:336-747-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor