MEDICARE: DR. DAVID HENRY FONKE D.C.

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	2691	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0836U	OTHER	NC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316955628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID HENRY FONKE D.C.

Provider Business Mailing Address
First Line	:	2018 FORT BRAGG RD
Second Line	:	SUITE 110A
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:	910-850-9646
Fax Number	:	910-483-0676

Provider Business Practice Location Address
First Line	:	2018 FORT BRAGG RD
Second Line	:	SUITE 110A
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:	910-850-9646
Fax Number	:	910-483-0676

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/28/2011

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