Provider Demographics
NPI:1720118722
Name:JONCA, KEVIN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PATRICK
Last Name:JONCA
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 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE #116
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-242-4422
Mailing Address - Fax:734-242-6774
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE #116
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-242-4422
Practice Address - Fax:734-242-6774
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKJ009044OtherBCBS- INDIVIDUAL