Provider Demographics
NPI:1710084850
Name:WRONKO, JON EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:EDWARD
Last Name:WRONKO
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 1:16806 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5509
Mailing Address - Country:US
Mailing Address - Phone:216-251-9585
Mailing Address - Fax:216-251-9064
Practice Address - Street 1:16806 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5509
Practice Address - Country:US
Practice Address - Phone:216-251-9585
Practice Address - Fax:216-251-9064
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 2616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166356Medicaid
OH4016241Medicare PIN