Provider Demographics
NPI:1659073674
Name:BURLINGTON CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BURLINGTON CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-689-1648
Mailing Address - Street 1:3008 S CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5686
Mailing Address - Country:US
Mailing Address - Phone:336-584-9932
Mailing Address - Fax:
Practice Address - Street 1:3008 S CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5686
Practice Address - Country:US
Practice Address - Phone:336-584-9932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty