Provider Demographics
NPI:1912349382
Name:FONKE, JONATHAN VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VINCENT
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 1:2006 NEW GARDEN RD
Mailing Address - Street 2:STE. 204
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2566
Mailing Address - Country:US
Mailing Address - Phone:336-545-3132
Mailing Address - Fax:336-545-0571
Practice Address - Street 1:2006 NEW GARDEN RD
Practice Address - Street 2:STE. 204
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2566
Practice Address - Country:US
Practice Address - Phone:336-545-3132
Practice Address - Fax:336-545-0571
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor