Provider Demographics
NPI:1245331453
Name:FONNER, JAMES EWING (DC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EWING
Last Name:FONNER
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 1:4303 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1577
Mailing Address - Country:US
Mailing Address - Phone:614-418-7122
Mailing Address - Fax:614-418-7124
Practice Address - Street 1:4303 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1577
Practice Address - Country:US
Practice Address - Phone:614-418-7122
Practice Address - Fax:614-418-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633216Medicaid
OH2633216Medicaid