Provider Demographics
NPI:1982646659
Name:FONKE, DANIEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:3132 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:
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890826WMedicaid
NC890826WMedicaid
NC2452395BMedicare ID - Type Unspecified