Provider Demographics
NPI:1316955628
Name:FONKE, DAVID HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
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 1:2018 FORT BRAGG RD
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7037
Mailing Address - Country:US
Mailing Address - Phone:910-850-9646
Mailing Address - Fax:910-483-0676
Practice Address - Street 1:2018 FORT BRAGG RD
Practice Address - Street 2:SUITE 110A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7037
Practice Address - Country:US
Practice Address - Phone:910-850-9646
Practice Address - Fax:910-483-0676
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0836UOtherBLUE CROSS BLUE SHIELD
NC8090836UMedicaid
2453349EMedicare ID - Type Unspecified
NC8090836UMedicaid