Provider Demographics
NPI:1447397989
Name:GREENSBORO CHIROPRACTIC INC
Entity Type:Organization
Organization Name:GREENSBORO CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FONKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-545-3132
Mailing Address - Street 1:3132 BATTLEGROUND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1915
Mailing Address - Country:US
Mailing Address - Phone:336-545-3132
Mailing Address - Fax:336-545-0571
Practice Address - Street 1:3132 BATTLEGROUND AVE
Practice Address - Street 2:STE. A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1914
Practice Address - Country:US
Practice Address - Phone:336-545-3132
Practice Address - Fax:336-545-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0826WOtherBCBS
NC890826WMedicaid
NC0826WOtherBCBS
NC890826WMedicaid