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Individual

DR. JEROME EARL FONKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
305 OWEN DR, FAYETTEVILLE, NC 28304-3410
(910) 484-5999
(910) 484-2523
Mailing address
205 OWEN DR, FAYETTEVILLE, NC 28304-3409
(910) 484-5999
(910) 484-2523

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1875
NC
111N00000X
Chiropractor
CHIR004818
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0840G
BCBS
NC
01
350047272
RAILROAD MEDICARE
NC
05
890823W
NC
Enumeration date
06/28/2005
Last updated
01/18/2017
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