MEDICARE: MR. JAMES EWING FONNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3599	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245331453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EWING FONNER DC

Provider Business Mailing Address
First Line	:	4303 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1577
Country	:	US
Telephone Number	:	614-418-7122
Fax Number	:	614-418-7124

Provider Business Practice Location Address
First Line	:	4303 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1577
Country	:	US
Telephone Number	:	614-418-7122
Fax Number	:	614-418-7124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/13/2023

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