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General NPI Number Information
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NPI Number | 1447397989
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Entity Type | Organization
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Legal Business Name | GREENSBORO CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 3132 BATTLEGROUND AVE STE. A
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City | GREENSBORO
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State | NC
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Zip | 27408-1914
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Country | US
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Telephone | 336-545-3132
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Fax | 336-545-0571
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Provider Business Mailing Address
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Address Line | 3132 BATTLEGROUND AVE STE A
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City | GREENSBORO
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State | NC
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Zip | 27408-1915
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Country | US
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Telephone | 336-545-3132
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Fax | 336-545-0571
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL J FONKE
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Credential | DC
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Telephone | 336-545-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2551
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License Number State | NC
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