Provider Demographics
NPI:1669681508
Name:PONCE, FERNANDO (DC)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:PONCE
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 1:2517 E MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1913
Mailing Address - Country:US
Mailing Address - Phone:517-487-8960
Mailing Address - Fax:517-487-8963
Practice Address - Street 1:2517 E MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1913
Practice Address - Country:US
Practice Address - Phone:517-487-8960
Practice Address - Fax:517-487-8963
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor