Provider Demographics
NPI:1073345740
Name:WINSTON-SALEM CHIROPRACTIC, INC
Entity type:Organization
Organization Name:WINSTON-SALEM CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-292-1963
Mailing Address - Street 1:2022 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-2934
Mailing Address - Country:US
Mailing Address - Phone:336-724-0597
Mailing Address - Fax:
Practice Address - Street 1:2022 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-2934
Practice Address - Country:US
Practice Address - Phone:336-724-0597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty